Wilkinson Michael C, Wu Esther
Department of Surgery, Loma Linda University Health, Loma Linda, USA.
Cureus. 2025 Aug 15;17(8):e90148. doi: 10.7759/cureus.90148. eCollection 2025 Aug.
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.
胆石性肠梗阻是胆石症患者中一种罕见但严重的并发症，会导致死亡风险增加，凸显了及时诊断和治疗的重要性。减重手术后体重过度减轻与更明显的症状性胆石症有关。我们报告一名44岁女性，曾接受垂直袖状胃切除术，现出现进行性加重的机械性小肠梗阻。计算机断层扫描显示有胆石症，磁共振胆胰管造影显示造影剂从胆囊渗入十二指肠。剖腹探查并取出肠石发现一枚大的胆石完全阻塞了空肠近端。对于既往接受减重手术且出现小肠梗阻症状的患者，胆石性肠梗阻的诊断需要高度怀疑。虽然最佳手术方式存在激烈争论，但一期手术应仅适用于临床状况良好的患者。胆石性肠梗阻是一种罕见但严重的诊断，并非仅见于合并症较多的老年人。需要进一步研究以评估减重手术后胆石性肠梗阻的发生率。
