We describe a rare case of small bowel obstruction and perforation secondary to a primary enterolith in an 84-year-old female patient with jejunal diverticulosis. She underwent an emergency laparotomy, small bowel resection and primary anastomosis. Multiple jejunal diverticula and a large stone were identified at the time of operation. Analysis of the stone demonstrated mainly faecal material consistent with a true primary enterolith. A literature search of Medline and PubMed revealed three cases similar to the one described. The pathogenesis and management of enterolithiasis in jejunal diverticular disease is considered.
DESCRIPTIONA 62-year-old woman presented with a 3-day history of dull right-sided abdominal pain, radiating to her groin and exacerbated by movement. Her background included breast cancer, for which she had a wide local excision and hormonal treatment with tamoxifen and anastrozole, previous duodenal ulcers, vaginal hysterectomy and total thyroidectomy. Her abdomen was soft but tender; she was not guarding and no palpable masses were evident. Her C reactive protein (CRP) was elevated at 103 and CT scan demonstrated mesenteric panniculitis (figures 1 and 2). She was managed conservatively with analgesics and her symptoms and CRP settled.'Misty mesentery' is a region of increased mesenteric fat density, compared with retroperitoneal fat, and gives a hazy impression.1 In this CT the Hounsfield Units (HU) of the small bowel mesentery were −53 compared with −118 HU for retroperitoneal fat. Misty mesentery is a non-specific feature on abdominopelvic CT scans as it simply represents increased density. This can be due to oedema, inflammation, haemorrhage, lymphoedema and neoplasia and these causes need to be excluded. 1Mesenteric panniculitis represents the inflammatory stage in a spectrum of idiopathic primary mesenteric pathologies referred to as mesenteric sclerosis.2 Histologically mesenteric sclerosis ranges from lipodystrophy to necrosis and fibrosis. The prevalence of mesenteric panniculitis on abdominopelvic CT scans is 0.6%.3 Typical features include a left-sided distribution, a 'fat halo' sign, nodules and a pseudotumorous hyperattenuation stripe.3 It is associated with malignancy, surgery, infection, autoimmune conditions and trauma and can be managed medically with analgesia and steroids. 2Learning points ▸ 'Misty mesentery' is a non-specific finding on CT scans and a cause for this should be sought. ▸ CT changes consistent with mesenteric panniculitis include positive findings; a left-sided distribution, 'fat-halo' sign, pseudotumorous hyperattenuation stripe, nodules and the absence of features suggesting haemorrhage, neoplasia, lymphoedema or other organ involvement.Contributors BC identified and managed the case, read and revised the paper. HT identified the radiological diagnoses and provided expertise in the revision of the paper. PAN collected the information, looked at the literature and drafted and revised the paper. He was the guarantor.Competing interests None.Patient consent Obtained.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.