Enterolith Causing Small Bowel Obstruction: Report of a Case and Review of Literature

Intraluminal causes of mechanical small bowel obstruction: CT findings and diagnostic approach

Intraluminal causes of small bowel obstruction (SBO) are less common than mural or extrinsic etiologies. This review categorizes intraluminal causes of SBO into four broad categories to provide a diagnostic framework for radiologic interpretation: 1) ingested contents, 2) bowel stasis, 3) inflammatory causes, and 4) neoplasms. Ingested materials can result in SBO when individual or accumulated contents are too large to pass, such as in the case of foreign bodies or bezoars. Bowel stasis causing SBO can be secondary to abnormal bowel function, such as in cystic fibrosis, reduced transit of contents at sites of narrowing such as surgical anastomoses, or the formation of enteroliths in diverticula which may subsequently dislodge and result in luminal obstruction. Inflammatory causes of SBO include strictures or fistulas that allow foreign bodies (such as gallstones) formed outside the bowel to enter the bowel lumen and cause obstruction. Finally, neoplasms can present as endophytic masses that occlude the bowel lumen through a ball-valve mechanism or serve as a lead point for intussusception. Recognizing the imaging features that are suggestive of intraluminal SBO is critical for accurate diagnosis and timely patient care.

Complicated jejunal diverticulitis with small bowel obstruction due to enterolith: A case report

INTRODUCTION AND IMPORTANCE

Small bowel diverticular disease (DD) is encountered and managed much less frequently than colonic DD, leading to a significantly less developed body of evidence for managing small bowel diverticulum and its associated complications.

CASE PRESENTATION

This case report discusses a rare occurrence of simultaneous perforated jejunal diverticulitis and mechanical small bowel obstruction (SBO) due to a migrating diverticular enterolith. The patient's condition was ultimately managed operatively through laparoscopically assisted small bowel resection.

CLINICAL DISCUSSION

A review of the literature reveals only eight reported cases of jejunal diverticulitis with simultaneous enterolith obstruction. All cases were managed operatively, with approaches including small bowel resection encompassing both pathologies, milking the enterolith back to the diverticulitis site and resecting en bloc to avoid extensive resection, or enterotomy and enterolith retrieval.

CONCLUSION

The prevalence of small bowel diverticular disease is increasing, and as a result, clinicians may encounter more complications associated with this condition in the future. This case highlights the importance of considering alternate complications of small bowel DD.

The role of computed tomography in enterolith causing small bowel obstruction: A case series

Intestinal obstruction caused by enteroliths is an uncommon medical condition. Timely detection of the presence of enteroliths and identification of their origin can guide clinical treatment. This study aimed to present the Computed Tomography (CT) features of enterolithic ileus confirmed by surgery in 7 patients. Seven patients with surgically confirmed enterolithic ileus who were admitted to our hospital between December 2013 and December 2022 were continuously enrolled, and an abdominopelvic CT examination was performed before surgery. The imaging characteristics were then analyzed. In the transition zone of all patients with intestinal obstruction, the sharply defined intraluminal masses were found. Three of them had gallstones and 4 had primary enteroliths. All 5 enteroliths in the 4 patients with primary enteroliths were in the proximal small intestine and were low-density with gas. Additionally, 3 gallstones were present in the distal small bowel, and calcifications were observed. Simultaneously, cholecystitis and secondary cholecystoduodenal fistula were observed in all 3 patients with gallstones. Compared to gallstones, primary enteroliths tend to be higher positioned, less dense, and accompanied by gas. CT examination is very important, as it allows accurate identification, location, diagnosis, and identification of complications of the different types of enteroliths to provide a basis for surgery.

Enterolithiasis: An unusual cause of large bowel obstruction, a case report

BACKGROUND

Large bowel obstruction is a common surgical condition encountered in the surgical emergency department. Large bowel obstruction due to primary enterolithiasis is an extremely uncommon condition. Enterolithiasis i.e. formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis due to various pathologies and can present in different clinical pictures to challenge a clinician.

CLINICAL PRESENTATION

a 60-year-old male farmer who had sigmoid resection and anastomosis six years back, currently presented with a complaint of recurrent abdominal cramps, progressive abdominal distension, vomiting, and constipation of 08 days duration. An examination showed a distended soft and non-tender abdomen. A plain abdominal x-ray showed an obstruction caused by enteroliths located at the proximal rectum. The patient was diagnosed with large bowel obstruction due to an impacted enterolith at the stenosed previous anastomotic site. Later, the patient was operated on, impacted enteroliths were removed, and was discharged improved.

CONCLUSION

definitive preoperative diagnosis of bowel obstruction due to enterolithiasis is not always possible. A high index of suspicion is very important to avoid misdiagnosis and delay in treatment. Most patients with enterolithiasis can be managed conservatively. However, surgery is the mainstay of treatment once conservative management fails.