The aspiration of contrast medium during the investigation of swallowing disorders is a well recognized hazard. It is therefore essential that the contrast medium administered is non-irritant to the lungs. A case is presented to illustrate the problems associated with the aspiration of a relatively non-irritant contrast medium.
An 88 year old woman presented with a one week history of vomiting, abdominal pain, and distension. Computed tomography of the abdomen showed obstruction of the distal small bowel by a lamellated calculus (arrow). Although initially thought to be a gallstone ileus, this diagnosis was refuted by the absence of pneumobilia and the observation of gallbladder stones with a different appearance from the obstructing calculus. Enteroliths similar to the obstructing calculus were seen, however, in several large jejunal diverticula. At laparotomy, a 3.5 cm enterolith was removed from the distal ileum. The patient made an uneventful recovery; rates of recurrence are unknown.
Patient consent obtained.Cite this as: BMJ 2015;350:h1920
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