{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T13:50:36Z","timestamp":1764856236210,"version":"3.46.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016646","name":"HCA Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016646","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Gallstone ileus is a rare complication of chronic cholelithiasis and an exceedingly uncommon cause of bowel obstruction following Roux-en-Y gastric bypass (RYGB), particularly after cholecystectomy. We report the first known case of a large gallstone causing obstruction of the biliopancreatic limb in an 80-year-old woman with prior RYGB, cholecystectomy, and choledochoduodenostomy. She underwent successful open enterolithotomy with stone extraction. This case highlights the diagnostic and technical challenges posed by altered post-RYGB anatomy and emphasizes the importance of maintaining a high index of suspicion in similar presentations. Early recognition and individualized operative management are critical to achieving favorable outcomes in this rare but potentially life-threatening condition.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf968","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T12:54:25Z","timestamp":1763211265000},"source":"Crossref","is-referenced-by-count":0,"title":["Biliopancreatic limb obstruction secondary to 9\u00a0cm gallstone nearly two decades following open Roux-en-Y gastric bypass and cholecystectomy: a rare and challenging case"],"prefix":"10.1093","volume":"2025","author":[{"given":"Elisabeth","family":"Barrar","sequence":"first","affiliation":[{"name":"Division of General Surgery and Trauma, Wake Forest University, Baptist Medical Center , Winstom Salem, NC 27157 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian M","family":"Simon","sequence":"additional","affiliation":[{"name":"Division of General Surgery, HCA Florida Orange Park Hospital , Orange Park, FL 32073, \u00a0","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Husain","family":"Abbas","sequence":"additional","affiliation":[{"name":"Division of Robotic, General, and Bariatric Surgery, HCA Florida Memorial Hospital , Jacksonville, FL 32216 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"2025120408472190900_ref1","doi-asserted-by":"publisher","first-page":"2083","DOI":"10.4240\/wjgs.v15.i9.2083","article-title":"Surgical management of gallstone ileus after one anastomosis gastric bypass: a case report","volume":"15","author":"El Feghali","year":"2023","journal-title":"World J Gastrointestinal Surg"},{"key":"2025120408472190900_ref2","doi-asserted-by":"publisher","first-page":"5539789","DOI":"10.1155\/2021\/5539789","article-title":"The regularity of the site of impaction in recurrent gallstone ileus: a systematic review and meta-analysis of reported cases","volume":"2021","author":"Alzerwi","year":"2021","journal-title":"Can J Gastroenterol Hepatol"},{"key":"2025120408472190900_ref3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.4068\/cmj.2021.57.1.91","article-title":"Gallstone ileus","volume":"57","author":"Shekhda","year":"2021","journal-title":"Chonnam Med J J"},{"key":"2025120408472190900_ref4","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1177\/0003134820923296","article-title":"Post-cholecystectomy gallstone ileus","volume":"86","author":"Meier","year":"2020","journal-title":"Am Surg"},{"key":"2025120408472190900_ref5","doi-asserted-by":"publisher","first-page":"30","DOI":"10.17476\/jmbs.2022.11.2.30","article-title":"Prevention of gallstones after bariatric surgery using ursodeoxycholic acid: a narrative review of literatures","volume":"11","author":"Son","year":"2022","journal-title":"J Metab Bariatr Surg"},{"key":"2025120408472190900_ref7","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1381\/096089203322190862","article-title":"Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery","volume":"13","author":"Oliveira","year":"2003","journal-title":"Obes Surg"},{"key":"2025120408472190900_ref6","doi-asserted-by":"publisher","first-page":"bcr2013200562","DOI":"10.1136\/bcr-2013-200562","article-title":"Cholecystoduodenal fistula in a patient post-Roux-en-Y gastric bypass","volume":"2013","author":"Hill","year":"2013","journal-title":"BMJ Case Rep"},{"key":"2025120408472190900_ref8","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1007\/s11695-019-04366-6","article-title":"Increased incidence of symptomatic cholelithiasis after bariatric Roux-en-Y gastric bypass and previous bariatric surgery: a single center experience","volume":"30","author":"Sneineh","year":"2020","journal-title":"Obes Surg"},{"key":"2025120408472190900_ref9","article-title":"Gallstone ileus after Roux-en-Y gastric bypass: a case report","volume":"20","author":"Zhang","year":"2024","journal-title":"Surg Obes Relat Dis"},{"key":"2025120408472190900_ref10","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ejrad.2003.10.018","article-title":"Gallstone ileus: analysis of radiological findings in 27 patients","volume":"50","author":"Lassandro","year":"2004","journal-title":"Eur J Radiol"},{"key":"2025120408472190900_ref11","doi-asserted-by":"publisher","first-page":"e33345","DOI":"10.7759\/cureus.33345","article-title":"Gallstone ileus post-cholecystectomy: a case review","volume":"15","author":"Helmy","year":"2023","journal-title":"Cureus"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/12\/rjaf968\/65739039\/rjaf968.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/12\/rjaf968\/65739039\/rjaf968.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T13:47:27Z","timestamp":1764856047000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf968\/8365098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,29]]},"references-count":11,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,11,29]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf968","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,11,29]]},"article-number":"rjaf968"}}