Review began 02/17/2023 Review ended 02/27/2023 Published 02/28/2023 © Copyright 2023 Hughes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Eight-Centimeter Gallbladder Stone Post-Roux- en-Y Gastric Bypass: A Case Report Lauren Hughes , Maryam Morris , Mohamed Hegazy , Fremita Fredrick , Frederick Tiesenga , Juaquito Jorge 1. Medicine, Saint James School of Medicine - Anguilla Campus, The Quarter, AIA 2. General Surgery, West Suburban Medical Center, Oak Park, USA 3. Surgery, Community Medical Center, Chicago, USA 4. Medicine, Saint James School of Medicine - St Vincent Campus, Arnos Vale, VCT 5. Surgery, Avalon University School of Medicine, Ohio, USA 6. General and Bariatric Surgery, West Suburban Hospital, Oak Park, USA Corresponding author: Lauren Hughes, lhughes@mail.sjsm.org Abstract Cholelithiasis occurs when a stone forms in the gallbladder; when symptoms develop, the condition is termed symptomatic cholelithiasis. The correlation between bariatric surgery and post-operative symptomatic cholelithiasis has long been established. Presented is a case of a 56-year-old female status post-Roux-en-Y gastric bypass who developed symptomatic cholelithiasis and subsequently underwent cholecystectomy with the removal of an 8-centimeter (cm) gallbladder stone. This case report explores the benefits and limitations of watchful waiting versus prophylactic concomitant cholecystectomy among bariatric surgery patients, noting the difference between the bariatric sleeve and bypass anatomy for managing biliary complications. Categories: Internal Medicine, Gastroenterology, General Surgery Keywords: giant gallbladder stone, s: bariatric, bariatric surgery/therapeutic use, bariatric medicine, roux-en-y gastric bypass (rygb), cholelithiasis, symptomatic cholelithiasis Introduction Cholelithiasis is a condition describing when a stone forms in the gallbladder. The two primary types of gallstones are cholesterol and pigment stones. Cholesterol stones are the predominant type in the United States and Western Europe, comprising 90% of cases. In the United States, approximately 20 million people have cholelithiasis; however, 70% to 80% do not experience any symptoms and are therefore classified as having asymptomatic cholelithiasis [1]. Yearly, 4% of those with asymptomatic cholelithiasis develop symptoms and are then classified or diagnosed with symptomatic cholelithiasis. Symptoms of cholelithiasis include excruciating pain in the right upper quadrant or epigastrium, typically following a fatty meal. The pain may also radiate to the back and right shoulder. Symptomatic cholelithiasis is an indication of cholecystectomy, a surgical procedure in which the gallbladder is removed, typically performed laparoscopically [1]. The pathogenesis of cholesterol stones involves gallbladder hypomotility, bile supersaturation with cholesterol, accelerated nucleation of cholesterol crystals, and mucus hypersecretion within the gallbladder, resulting in the trapping of nucleated crystals [2]. Risk factors precipitating stone formation include age, sex, oral contraceptive pill (OCP) use, obesity, rapid weight loss, and gallbladder stasis [2]. Bariatric surgery and the resultant, often rapid, weight loss has been linked to symptomatic cholelithiasis and is of particular interest. Bariatric surgeries available to patients include laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), and duodenal switch [3]. Research has shown that the likelihood of developing symptomatic cholelithiasis is increased with each procedure. However, there are varying degrees in the extent each procedure increases the likelihood of developing symptomatic cholelithiasis. For example, RYGB had a 6% to 50% incidence compared to approximately 1% to 8% in laparoscopic sleeve gastrectomy and roughly 4% in laparoscopic gastric banding [4]. Case Presentation A 56-year-old female with a past medical history significant for morbid obesity status post gastric bypass with concomitant weight loss, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, and obstructive sleep apnea presented to the outpatient surgery office with complaints of abdominal bloating, gas, heartburn/dyspepsia, and epigastric pain. The patient initially complained of intermittent abdominal bloating and gas but then reported heartburn/dyspepsia and epigastric pain, specifically postprandial right upper quadrant (RUQ) pain. The patient denied chest pain, shortness of breath, or difficulty breathing. The patient’s surgical history was only positive for RYGB undergone two years prior. The patient was able to essentially resolve DM with a most recent hemoglobin A1C level of 5.9% and showed significant improvement in COPD, hypertension, and OSA conditions and symptoms; however, these conditions were 1, 2 3 4, 2 5 2 6 Open Access Case Report DOI: 10.7759/cureus.35604 How to cite this article Hughes L, Morris M, Hegazy M, et al. (February 28, 2023) Eight-Centimeter Gallbladder Stone Post-Roux-en-Y Gastric Bypass: A Case Report. Cureus 15(2): e35604. DOI 10.7759/cureus.35604