Large Jejunal Gallstone Ileus After Sleeve Gastrectomy

Gallstone ileus is a rare but serious complication in patients with cholelithiasis, resulting in an increased risk of mortality, highlighting the importance of timely diagnosis and management. Excess weight loss after bariatric surgery is associated with more pronounced symptomatic gallstone disease. We present a 44-year-old female with a previous vertical sleeve gastrectomy who presented with progressively worsening mechanical small bowel obstruction. Computed tomography showed cholelithiasis, and magnetic resonance cholangiopancreatography identified extravasation of contrast from the gallbladder to the duodenum. Laparotomy with enterolithotomy revealed a large gallstone completely obstructing the proximal jejunum. In patients with prior bariatric surgery presenting with symptoms of small bowel obstruction, the diagnosis of gallstone ileus requires a high index of suspicion. While the optimal procedure is heavily debated, one-stage procedures should be reserved for patients who are clinically optimized. Gallstone ileus is a rare but serious diagnosis not isolated to the comorbid elderly. Further studies are needed to assess the incidence of gallstone ileus after bariatric surgery.