What can cause an elevated billirubin count after gallbladder removal?

Depends on level: Some minor elevation of bilirubin can occur from swelling of the bile duct but should be very short lived. Marked elevation or prolonged elevation (assuming normal levels pre-operatively) should be evaluated promptly, with ultrasound and in some cases, x-rays of the bile duct (also called ERCP or mrcp). Any other associated symptom, like abdominal pain, fever, should necessitate emergent tests.