A Rare Case of Biliary Bezoar in the Biliopancreatic Limb after Laparoscopic One-anastomosis Gastric Bypass

Biliary bezoars are exceptionally rare entities, particularly within the biliopancreatic limb following bariatric surgery. Obstruction secondary to a biliary bezoar after laparoscopic one-anastomosis gastric bypass (OAGB) is an unusual but important postoperative complication that can mimic more common causes of biliary or intestinal obstruction. We report the case of a 51-year-old male with a history of morbid obesity who underwent laparoscopic OAGB 7 years earlier. He presented with intermittent abdominal pain and bloating for 2 weeks. Imaging revealed dilatation of the biliopancreatic limb and proximal small bowel. Diagnostic laparoscopy revealed a hugely dilated biliopancreatic limb. Laparotomy and enterotomy exposed a biliary bezoar, which was successfully removed. The patient recovered uneventfully, with complete resolution of symptoms. Biliary bezoar obstruction within the biliopancreatic limb is a rare but treatable cause of post-OAGB morbidity. Awareness of this entity and prompt laparoscopic intervention are essential for optimal outcomes.