Gallstone in a duodenal diverticulum is probably secondary to changes in the enterohepatic bile cycle and anatomy induced by the RYGB. The migration of the stone from the duodenal diverticulum is responsible of the small bowel obstruction. The combination of abdominal pain, duodenal diverticulum and history of RYGB should be investigated for a biliary complication of the diverticulum.
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