title: Gallstone ileus without bilioenteric fistula years after bypass surgery for Crohn's disease. Case report and clues to etiology of a neglected cause of obstruction.
abstract: BACKGROUND
  Gallstone ileus is a very rare cause of bowel obstruction. Patients suffering from Crohn's disease are at increased risk of developing gallstone disease, especially when terminal ileum is involved. Gallstone ileus can occur, but etiology remains controversial. We report on a case of such a rare condition, illustrating etiology and treatments.
  
  
  METHODS
  A patient with long-standing Crohn's disease, who had undergone ileotransverse bypass for ileocaecal involvement 40 years before, presented with cramp-like abdominal pain. Imaging was consistent with a gallstone ileus with no evidence of bilioenteric fistulae.
  
  
  CONCLUSIONS
  At surgery, we found gallstones stuck at the site of ileotransverse anastomosis. No bilioenteric fistulae were found. Due to disease progression, many enteric fistulae were found, requiring a massive bowel resection. The diverted segment may have been responsible of gallstone formation, and etiology is discussed. Recovery after surgery was uneventful, but the patient required continued nutritional support.
  
  
  CONCLUSIONS
  Physicians dealing with Crohn's disease patients with bypassed segments should keep in mind, the increased risk of gallstone formation, in order to not overlook gallstone ileus. Early suspect and diagnosis may allow for less aggressive approaches. A diverted segment should always be removed, and long-term follow-up encouraged.
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy. Electronic address: gipe1984@gmail.com.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pellino
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Candilio
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: G Serena
authors.initials: GS
authors.lastname: De Fatico
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Marcellinaro
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Giulio C
authors.initials: GC
authors.lastname: Formicola
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Volpicelli
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Sciaudone
authors.affiliation: Unit of Gastroenterology, Second University of Naples, Naples, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Riegler
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Silvestro
authors.initials: S
authors.lastname: Canonico
authors.affiliation: Unit of General Surgery, Second University of Naples, Naples, Italy. Electronic address: fselvaggi@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Selvaggi
keywords: Bypass; Complication; Crohn’s disease; Gallstone; Gallstone ileus; Inflammatory bowel disease