Large Enterolith Complicating a Meckel Diverticulum Causing Obstructive Ileus in an Adolescent Male Patient

Abstract

We present a unique case of a 16-year-old male patient who was eventually diagnosed with a large enterolith arising from a Meckel's diverticulum. The enterolith had caused intermittent intestinal symptoms for three years before resulting in small bowel obstruction requiring surgical intervention. Meckel's enterolith ileus is very rare with only few cases described in the literature. To our knowledge, this is only the second case of Meckel's enterolith which had caused intermittent symptoms over a period of time, before resulting in ileus, and the first case where the intermittent symptoms lasted several years before bowel obstruction. The patient had been evaluated with colonoscopy, computerized tomography (CT), and magnetic resonance imaging enterography (MRIE); a calcified pelvic mass had been found, but no further diagnosis other than calcification was established. The patient presented at our emergency department, with symptoms of obstructive ileus and underwent exploratory laparotomy, where a large enterolith arising from a Meckel's diverticulum (MD) was identified, causing the obstruction. A successful partial enterectomy, enterolith removal, and primary end-to-end anastomosis took place; the patient was permanently relieved from his long-standing symptoms. Consequently, complications of Meckel's diverticulum and enterolithiasis have to be included in the differential diagnosis of abdominal complaints.

Calcified stone in intestinal blind loop after 60 years of surgical treatment of complex jejunal atresia: an attempt to understand an enigma

“…To our knowledge this is the first case report of intestinal obstruction with formation of a large stone 60 years after repair of duodenal atresia (table 1, figures 3–6). Enterolith formation is reported in the literature in Meckles diverticulum, Crohn’s disease and following R-Rouex abdominal surgery 5–7. The enterolith was also reported in jejunum, ileum and in association with diverticulitis 8 9.…”

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

“…The true primary enteroliths reported in recent literatures were all located in the distal small intestine, with high-density calcification. [4–6,12–17] This is because they may contain calcium phosphate, calcium oxalate, and calcium carbonate. [17,18] Mottled gas appearance is a characteristic CT finding in false primary enteroliths.…”

“…The true primary enteroliths reported in recent literatures were all located in the distal small intestine, with high-density calcification. [4][5][6][12][13][14][15][16][17] This is because they may Figure 2. CT scans in the coronal and axial planes show five primary enteroliths that appear to be unevenly low-density with a mottled gas appearance (arrow).…”

“…In addition, studies of enteroliths causing SBO have mostly been isolated case series or reports in the recent literature. [4][5][6][7][8] Thus, we attempted to identify the CT signs of enterolithic ileus confirmed by surgery in 7 patients and the differences between the 2 types of enteroliths. The results of this study will hopefully provide a basis for CT signs to accurately predict SBO caused by enteroliths.…”

“…In addition, studies of enteroliths causing SBO have mostly been isolated case series or reports in the recent literature. [4–8]…”