A Severely Dilated Gallbladder With Multiple Gallstones After Concomitant Laparoscopic Sleeve Gastrectomy and Childbirth in a Hispanic Woman

Abstract

Independent studies have associated laparoscopic sleeve gastrectomy (LSG) and pregnancy with a higher incidence of gallstones, especially in Hispanic populations. However, the synergistic impact of these risk factors is currently unknown. We present the case of a 42-year-old Hispanic woman who initially identified intermittent upper right abdominal pain, which worsened over the last four days before the presentation. Abdominal ultrasound indicated hepatic steatosis, hepatomegaly, and cholelithiasis. A hydropic gallbladder with numerous gallstones, surrounding pericholecystic inflammatory changes, and mild intra-abdominal and pelvic ascites was confirmed by computed tomography. The patient underwent an uneventful robotic-assisted cholecystectomy. A gross examination of the gall bladder measuring 15.5 x 6 x 5.5 cm revealed multiple stones measuring 1.0-1.5 cm in the lumen, the largest of which was impacted in the neck. This case underscores the importance of considering ethnicity and pregnancy history while assessing the post-LSG risk of incident cholelithiasis.

Keywords: bariatric; gallbladder; laparoscopic; nonalcoholic fatty liver disease; s: cholelithiasis.

Figure 1. Ultrasound and computed tomography scans. (A, B) An oblique sonogram shows an enlarged gallbladder with several gallstones. (C) A color Doppler sonogram shows a common bile duct of 8 mm. (D, E) Computed tomography scans show an enlarged gallbladder with several gallstones and hepatomegaly.

Figure 2. A highly distended gallbladder measuring 15.5 x 6 x 5.5 cm.