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

tINTRODUCTION: Gallstone ileus is a very rare cause of bowel obstruction. Patients suffering from Crohn’sdisease 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.PRESENTATION OF CASE: A patient with long-standing Crohn’s disease, who had undergone ileotransversebypass for ileocaecal involvement 40 years before, presented with cramp-like abdominal pain. Imagingwas consistent with a gallstone ileus with no evidence of bilioenteric fistulae.DISCUSSION: At surgery, we found gallstones stuck at the site of ileotransverse anastomosis. No bil-ioenteric fistulae were found. Due to disease progression, many enteric fistulae were found, requiringa 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 continuednutritional support.CONCLUSION: Physicians dealing with Crohn’s disease patients with bypassed segments should keep inmind, the increased risk of gallstone formation, in order to not overlook gallstone ileus. Early suspect anddiagnosis may allow for less aggressive approaches. A diverted segment should always be removed, andlong-term follow-up encouraged.