Enterolith and small bowel perforation in Crohnʼs disease

Muthukumarasamy, Girivasan; Nairn, E R; McMillan, I. K. R.

doi:10.1002/ibd.21803

Cited by 10 publications

(13 citation statements)

References 3 publications

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“…However, clinically significant enteroliths are more likely to develop in certain medical conditions. Primary enteroliths are classically formed in the areas of stasis within the bowel in the presence of the intestinal diverticula, surgical side-to-side enteroanastomoses, blind pouches (cul-de-sac), afferent loops in the Billroth Ⅱ gastrojejunostomy and Roux-en-Y procedures, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, or proximal to the intestinal strictures encountered in cases of Crohn's disease and intestinal tuberculosis [8][9][10][11][12][13][14][15][16][17][18] . It is difficult to quantify true incidence of the enterolithiasis in the setting of small intestinal diverticular disease.…”

Section: Epidemiologymentioning

confidence: 99%

“…Variations in structural integrity of the intestine may be seen in the diverticular disease (congenital and acquired) [8,9] ; surgical entero-anastomoses [14] , afferent or Roux loops [10] , blind pouches [13] ; stricturing or stenosing disease of the bowel seen in infectious and inflammatory conditions (tuberculosis, Crohn's disease) [11,12] ; radiation or eosinophillic enteritis [15,51] ; mucosal diaphragmatic disease [52] ; intestinal duplication [53,15] ; fistula [54] ; malignancy [55] ; and finally in apparent kinking of the gut that is found in patients with intra-abdominal adhesions, external compressions, or incarcerated hernias [15][16][17][18] . Other conditions associated with increased risk of enterolith production include intestinal aganglionosis, intestinal amoebiasis, and ischemic enteritis [15] .…”

Section: Etiologymentioning

confidence: 99%

“…Such enteroliths are most often found within the areas of aneurismal, saccular, or dilated parts of the intestine [43,45] . They may be single or multiple, a concept largely related to the number of stenotic or structuring areas of the intestine, each predisposing to stone formation [12] . Common affinity of the Crohn's disease to the neo-terminal ileum makes calcified enterolith formation there most common [43,52] .…”

Section: Etiologymentioning

confidence: 99%

“…Spontaneous passage of a larger stone is unlikely and a thorough search for an underlying pathology should be performed. In cases of intestinal stricturing, stenosis, or an anastomotic defect, an attempt at endoscopic segment dilatation and stone retrieval may be considered first [12,89] . Endoscopic electrohydraulic lithotripsy and mechanical lithotripsy have been previously described [84,90] .…”

Section: Treatmentmentioning

confidence: 99%

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Enterolithiasis

Gurvits¹,

Lan²

2014

WJG

194

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Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis in the presence of the intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, and stenosing or stricturing Crohn's disease and intestinal tuberculosis. Enterolithiasis is classified into primary and secondary types. Its prevalence ranges from 0.3% to 10% in selected populations. Proximal primary enteroliths are composed of choleic acid salts and distal enteroliths are calcified. Clinical presentation includes abdominal pains, distention, nausea, and vomiting of occasionally sudden but often fluctuating subacute nature which occurs as a result of the enterolith tumbling through the bowel lumen. Thorough history and physical exam coupled with radiologic imaging helps establish a diagnosis in a patient at risk. Complications include bowel obstruction, direct pressure injury to the intestinal mucosa, intestinal gangrene, intussusceptions, afferent loop syndrome, diverticulitis, iron deficiency anemia, gastrointestinal hemorrhage, and perforation. Mortality of primary enterolithiasis may reach 3% and secondary enterolithiasis 8%. Risk factors include poorly conditioned patients with significant obstruction and delay in diagnosis. Treatment relies on timely recognition of the disease and endoscopic or surgical intervention. With advents in new technology, improved outcome is expected for patients with enterolithiasis.

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Section: Epidemiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Enterolithiasis

Gurvits¹,

Lan²

2014

WJG

194

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“…Once symptoms appear, however, critical clinical conditions which require surgical treatment, such as ileus and intestinal perforation may arise (2). Recently, several reports have suggested that conventional endoscopy may be a therapeutic option in selected cases (3)(4)(5)(6)(7). However, since conventional endoscopy carries certain limitations in the approach to the whole small intestine, the application of balloon-assisted enteroscopy to enterolith management has been expected (2).…”

Section: Introductionmentioning

confidence: 99%

True Primary Enterolith Treated by Balloon-assisted Enteroscopy

et al. 2015

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Primary enterolith is a rare condition that can induce ileus and intestinal perforation. We report the first case of a true primary enterolith treated by balloon-assisted enteroscopy. The patient presented with a small intestinal ileus. After its improvement following the insertion of an ileus tube, radiography with amidotrizoate sodium meglumine detected a round, movable defect in the ileum measuring 42 mm diameter. The patient was diagnosed with a primary enterolith based on her past history. The enterolith was fractured and removed using balloon-assisted enteroscopy. This case suggests that balloon-assisted enteroscopy may be an effective non-invasive treatment option for enteroliths.

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Small-bowel obstruction associated with Crohn’s enterolith

2013

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One of the lesser known clinical manifestations of Crohn's disease is the formation of small-bowel enteroliths. These concretions precipitate in the setting of small-bowel stasis within the alimentary tract and are associated with a variety of disease states causing strictures or diverticula. In the acute setting, patients typically present with signs of intestinal obstruction due to stone impaction. The case we report involves a 67-year-old female with long-standing Crohn's disease who presented with a 6-day history of worsening abdominal pain. Plain abdominal radiographs demonstrated dilated bowel loops consistent with intestinal obstruction. Computed tomography revealed a 2.5-cm calcified density at the transition point in the distal ileum, and two additional stones were present in the proximal ileum. At surgery, multiple ileal strictures were found, and ileocolic resection with primary anastomoses was performed. The accurate diagnosis of enterolithiasis in the setting of Crohn's disease has significant clinical implications for management and is a harbinger of underlying bowel stenosis.

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Enterolith and small bowel perforation in Crohnʼs disease

Cited by 10 publications

References 3 publications

Enterolithiasis

Enterolithiasis

True Primary Enterolith Treated by Balloon-assisted Enteroscopy

Small-bowel obstruction associated with Crohn’s enterolith

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