Background

Small bowel obstruction due to gallstone ileus is a rare complication of bariatric surgery. A 51-year-old female with a history of gastric bypass 18 years prior presented to the emergency department with three days of persistent nausea, vomiting, and distension. CT imaging on admission found a high grade, small bowel obstruction with transition point likely in the right lower quadrant and with pneumobilia. The patient was taken to the operating room for an exploratory laparotomy. A 5.0 x 3.2 x 2.9 cm gallstone was extracted via enterolithotomy with stone extraction. The patient's post-operative course was complicated by a perihepatic abscess. After rapid weight loss status post bariatric surgery, patients have an increased risk of biliary disease - most commonly being symptomatic cholelithiasis and acute cholecystitis. However, gallstone ileus is a rare complication and can be difficult to diagnose, which delays prompt surgical management. Therefore, there must be continued vigilance in recognizing biliary disease including gallstone ileus in the gastric bypass patients and preventing complications of biliary disease within the bariatric surgery population.