Small-bowel obstruction after modified jejunoileal bypass surgery due to gallstone ileus

Abstract

In modified jejunoileal bypass (MJB), first described by Iraj Fazel in 1982, two points of SB, 15 cm after Treitz' ligament and 45 cm proximal to illeocecal valve, are resected and anastomosed, and the remaining resected bowel is anastomosed to the gallbladder and cecum[4] that acts as a bilioenteric fistula and can lead to gallstone ileus due to an increased risk of gallstone formation after severe weight loss. [2] A 45-year-old female with body mass index (BMI) of 31 kg/m2 was admitted to the emergency department of our academic hospital, with colicky abdominal pain, nausea, and vomiting in the recent 3 days. {Figure 1}{Figure 2} Gallstone ileus has nonspecific symptoms such as abdominal pain, constipation, nausea, or vomiting; is more frequent in females and older patients;[2],[5] and often needs emergent surgical management of obstruction that is performed laparoscopically in 10% of cases.