title: Gallstone ileus after biliointestinal bypass: report of two cases.
abstract: BACKGROUND
  Gallstone ileus is an uncommon disease and accounts for 1-4 % of all cases of mechanical intestinal obstruction. The physiopathology is related to the presence of a bilioenteric fistula.
  
  
  METHODS
  We report two cases of gallstone ileus in patients operated on biliointestinal bypass for morbid obesity. The anastomosis of the gallbladder to the proximal end of the bypassed jejunum allowed the transit of gallstones in the excluded ileum and its impaction in anti-reflux valvular system.
  
  
  RESULTS
  Preoperative exams were unable to solve the diagnostic query, and the diagnosis was achieved only at laparotomy. One-stage combined enterolithotomy and cholecystectomy were performed.
  
  
  CONCLUSIONS
  The two patients had an uneventful recovery. To our knowledge, this is the first report of gallstone ileus after biliointestinal bypass.
authors.affiliation: Department of Pathophysiology and Transplantation-Department of General Surgery, Università degli Studi di Milano-Istituto Clinico Sant'Ambrogio, via Faravelli 16, 20149, Milan, Italy, giancarlo.micheletto@unimi.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Micheletto
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Danelli
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.forename: Valerio
authors.initials: V
authors.lastname: Panizzo
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D002769:Cholelithiasis / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology* / Q000503:physiopathology; D007581:Jejunoileal Bypass / Q000009:adverse effects*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D014057:Tomography, X-Ray Computed
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