An Unusual Cause of Small Bowel Obstruction: A Case Report

Fecaloma causing small bowel obstruction in the absence of risk factors: a case report

BACKGROUND

Small bowel obstruction is a common surgical emergency typically caused by adhesions, hernias, and malignancies. However, ileal fecalomas represent an exceptionally rare etiology, with few cases reported in literature. This case study and literature review aim to highlight an unusual cause of small bowel obstruction, emphasizing the diagnostic challenges and management strategies.

CASE PRESENTATION

A 60-year-old Middle Eastern female patient from Syria with a 1-year history of chronic constipation presented with abdominal pain, vomiting, and an inability to pass feces. Diagnostic imaging confirmed small bowel obstruction, which was caused by a fecal mass proximal to the ileocecal junction. Surgical extraction successfully resolved the obstruction.

CONCLUSION

This case underscores the importance of considering fecal impaction as a differential diagnosis in patients with chronic constipation and highlights the effectiveness of surgical intervention in resolving such obstructions. A comprehensive review of literature on unusual causes of small bowel obstruction, including imaging characteristics and management approaches, is also provided to enhance clinical awareness and improve patient outcomes.

A Rare Case of Small Bowel Obstruction in Pregnancy Due to Adenocarcinoma

Small bowel obstruction (SBO) rarely occurs in pregnancy, primarily due to the adhesions resulting from previous abdominal surgery. However, malignancy causing SBO during pregnancy is exceedingly rare. We present a case of a 34-year-old pregnant woman who was recently diagnosed with small bowel disease at 19 weeks and two days of gestation and initially managed conservatively. Diagnostic procedures, such as endoscopy or colonoscopy and enterography magnetic resonance imaging (MRI), were postponed due to her pregnancy. With recurrent episodes of worsening symptoms, the patient underwent multiple admissions, during which an abdominal X-ray was performed, revealing dilated loops of the small and large bowel, highly suggestive of SBO. Subsequently, a plain abdominal MRI revealed a stricture in the left lower quadrant, resulting in SBO. Given the absence of a fetal pulse, the patient underwent an emergency laparotomy. Surgical resection involving part of the mass in the terminal ileum was performed, followed by a primary side-to-side anastomosis. Histopathological examination of the resected tissue confirmed the presence of small bowel adenocarcinoma. The successful surgical resection and subsequent histopathological confirmation emphasized the importance of prompt diagnosis and appropriate management. This case underscores the challenges faced in diagnosing and managing small bowel obstruction during pregnancy, particularly when malignancy is the underlying cause. It highlights the need to balance diagnostic investigations with fetal safety. Multidisciplinary collaboration between obstetricians, surgeons, and radiologists is crucial in navigating the complexities of managing such cases and ensuring optimal outcomes for both the mother and the fetus.

Jejunal Enterolith: A Rare Case of Small Bowel Obstruction

Small bowel obstruction is a common operative finding following an acute surgical admission. However, small bowel obstruction due to an enterolith is a rarer finding. Enteroliths are formed in conditions contributing to hypomotility and stasis within the gastrointestinal tract. These include Crohn's disease, strictures, and intestinal diverticulae. We present a case of small bowel obstruction due to an enterolith in an 89-year-old female. In our case, CT identified an inflamed jejunal diverticulum pre-operatively.

Afferent loop obstruction with obstructive jaundice and ileus due to an enterolith after distal gastrectomy: A case report

INTRODUCTION

Afferent loop obstruction is an uncommon complication associated with Billroth II reconstruction or Roux-en-Y reconstruction after gastrectomy. Moreover, cases where the obstruction is caused by enterolith are rare. Here, we report a rare case of afferent loop obstruction caused by an enterolith after Roux-en-Y reconstruction of gastrectomy; subsequently, leading to ileus in the ileum.

PRESENTATION OF CASE

An 84-year-old man who received a Roux-en-Y distal gastrectomy for gastric cancer presented with symptoms of fever and jaundice 14 months later. Computed tomography (CT) scan revealed an enterolith in the duodenal afferent loop and a dilated intrahepatic bile duct. Although the obstructive jaundice and fever disappeared with conservative therapy, ileus occurred due to the movement of the enterolith into the ileum, which was refractory to conservative therapy. Therefore, enterotomy was performed to remove the enterolith, and the patient had an uneventful recovery. Histologically, the enterolith derived from food residue. No postsurgical sign of recurrence has been noted for 6 months.

CONCLUSION

We report a rare case where an enterolith in a duodenal afferent loop after distal gastrectomy led to obstructive jaundice, and subsequently, caused ileus by its movement into the ileum.