Primarily Proximal Jejunal Stone Causing Enterolith Ileus in a Patient without Evidence of Cholecystoenteric Fistula or Jejunal Diverticulosis

Abstract

Stone formation within the intestinal lumen is called enterolith. This stone can encroach into the lumen causing obstruction and surgical emergency. Jejunal obstruction by an enterolith is a very rare entity and often missed preoperatively. To our knowledge, most cases of jejunal obstruction, secondary to stone, were associated with biliary disease (cholecystoenteric fistula), bezoar, jejunal diverticulosis, or foreign body. Hereby we present a rare case report of small bowel obstruction in an elderly man who was diagnosed lately to have primary proximal jejunal obstruction by an enterolith without evidence of a cholecystoenteric fistula or jejunal diverticulosis. This patient underwent laparotomy, enterotomy with stone extraction, and subsequent primary repair of the bowel.

Clinical characteristics and indications for surgery for bezoar-induced small bowel obstruction

“…1 Rarely, bowel obstruction can be caused by a bezoar, or a mass of undigested foreign material. 2 Bezoars are gastrointestinal intraluminal stones, 3 and their formation is related to various factors, such as gastrointestinal motility disorders and gastrointestinal surgery for intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, and stenosing or strictures secondary to Crohn’s disease and intestinal tuberculosis. 4 Bezoars may be found anywhere in the gut but most reside in the stomach 5 and enter the small intestine via the pylorus.…”

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

“…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. Interestingly, enterolith was also associated with iron deficiency anaemia especially in the jejunum 10.…”

Cola Dissolution Therapy via Ileus Tube Was Effective for Ileus Secondary to Small Bowel Obstruction Induced by an Enterolith

“…A previous study noted that the non-oxyntic mucosa of the small bowel creates an alkaline environment in which calcium oxalate crystals form within the bile and other bowel contents, resulting in enteroliths (12). Reports on the histology of enteroliths have demonstrated the presence of bile salts (1,12). In the present case, the HU values of the enterolith on CT ranged from 31 to 134, and the excreted enterolith contained calcium phosphate, bilirubin calcium, and cholesterol.…”

“…Enteroliths are intestinal intraluminal stones (1). Enterolithiasis, or the formation of gastrointestinal concretions, is an uncommon medical condition that develops in the setting of intestinal stasis in the presence of intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, and stenosing or stricturing due to Crohn's disease and intestinal tuberculosis (2).…”