A case of perforation of Meckel's diverticulum with enterolith

Meckel's Diverticulum Enterolith: A Rare Cause of Perforation and Small Bowel Obstruction Presenting as Acute Abdomen

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. MD enteroliths are an uncommon entity that could rarely present with complications.

We, herein, present a case of a 56-year-old man who presented with severe abdominal pain. Preoperative CT showed an inflamed structure with central calcification connected to distal ileum lumen with an air pouch associated with small bowel obstruction. Upon laparotomy, a perforated MD was found with phlegmon formation. He underwent resection of the loops containing MD with end-to-end anastomosis. 

This highlights the importance of radiological imaging in preoperative diagnosis of these conditions which should be kept in mind if we find a calcified lesion in an inflamed diverticulum around the midline region.

Nontraumatic perforation of the small intestine caused by true primary enteroliths associated with radiation enteritis: a case report

Background

True primary enterolithiasis is an uncommon condition, and nontraumatic perforation of the small intestine (NTPSI) is also an unusual entity. Therefore, NTPSI due to true primary enteroliths is an exceptionally rare complication. Moreover, enterolithiasis and radiation enteritis are also unique combinations. Herein, we present an exceedingly rare case of NTPSI induced by multiple true primary enteroliths associated with radiation enteritis.

Case presentation

A 92-year-old woman with acute abdominal pain was transferred to our hospital because a computed tomography (CT) scan performed by her family doctor revealed free air and fluid collection within her abdomen. Our initial diagnosis was upper gastrointestinal perforation, and we selected nonoperative management (NOM) with adnominal drainage. Although her general condition was stable, jejunal juice was drained continuously. Given that the CT performed 10 days after onset demonstrated perforation of the small intestine and adjacent concretion, we performed an emergency partial resection of the small intestine and jejunostomy. The resected bowel was 1 m in length and had many strictures that contained multiple enteroliths in their proximal lumens. The patient’s postoperative course was uneventful. The enteroliths were composed of deoxycholic acid (DCA). She was diagnosed with peritonitis due to NTPSI derived from multiple true primary enteroliths associated with radiation enteritis, as she had previously undergone hysterectomy and subsequent internal radiation therapy.

Conclusions

Clinicians should consider the rare entity of true primary enteroliths associated with radiation enteritis in NTPSI cases with unknown etiologies.

Rare case of a patient with symptomatic Meckel's diverticulum enteroliths

A 61-year-old man presented with non-specific abdominal symptoms, including left groin pain and change in bowel habits. Investigations revealed a cystic lesion, containing numerous irregular calcifications, with the primary differential being a dermoid cyst containing teeth-like calcifications. At laparoscopy it was found to be a Meckel's diverticulum, containing a large number of enteroliths. This case revealed the importance of considering enteroliths in patients with imaging showing intra-abdominal calcifications, and laparoscopy for diagnosis and treatment.