DOCSLIB.ORG

Jejunal Obstruction Caused by a Calcified Enterolith

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Jejunal Obstruction Caused by a Calcified Enterolith A CASE TO REMEMBER Jejunal Obstruction Caused by a Calcified Enterolith by Nolan E. Perez, Cherie R. Phillips, John D. Webber, Cristina B. Guzman, Faysal A. Saksouk and Murray N. Ehrinpreis Nolan E. Perez Murray N. Ehrinpreis A 98-year-old woman presented with several weeks of nausea, vomiting, abdominal pain and anorexia, and was found to have a persistent small bowel obstruction (SBO). A 4 × 3 cm calcified mass was discovered in the small bowel on computed tomography causing suspicion for gallstone ileus. The diagnosis of a calcified enterolith was made after exploratory laparoscopy given the absence of findings for gallstone ileus and the composition of the large amorphous stone. Small bowel obstruction resulting from stone impaction is very rare, with most cases caused by a gallstone ileus or by an enterolith formed in a small bowel diverticu- lum. We report the second case of proximal SBO caused by a calcified enterolith, but our case is unique due to the absence of small bowel diverticula. Nolan E. Perez, M.D., Division of Gastroenterology; Cherie R. Phillips, M.A.; John D. Webber, M.D., Department of Surgery; Cristina B. Guzman, M.D., Division of Endocrinology; Faysal A. Saksouk, M.D., Department of Radiology; Murray N. Ehrinpreis, M.D., Division of Gastroen- terology; all at Wayne State University School of Medicine, Detroit, MI. PRACTICAL GASTROENTEROLOGY • JANUARY 2006 49 Jejunal Obstruction Caused by a Calcified Enterolith A CASE TO REMEMBER Fig. 1. Calcified mass in the small bowel located in the Fig. 2. Dilated proximal small bowel filled with air and fluid. pelvis. INTRODUCTION Due to advanced age, previous stroke and dementia, rimary enteroliths are formed in the small bowel she was mostly bedridden and cared for by her family and secondary enteroliths (gallstones) are at home. P formed in the gallbladder (1). In the differential On examination the patient was afebrile and had diagnosis of a small bowel obstruction (SBO) occur- mild tachycardia. The abdomen was distended with ring in the elderly, one should always consider gall- increased bowel sounds and mild tenderness. There stone ileus, which occurs when a gallstone is passed were no hernias. White blood cell count was 13,200 through a biliary-enteric fistula. Gallstone ileus is well cells/cumm and hemoglobin 11.2 g/dL. Electrolytes, described, but there are few reported cases of primary amylase, lipase and liver tests were normal. Computed enteroliths causing SBO. Herein, we report an exceed- tomography (CT) revealed a 4 × 3 cm calcified mass in ingly rare case of a calcified enterolith causing jejunal the small bowel, located in the pelvis, with dilated obstruction without associated small bowel divertic- proximal loops (Figures 1–2). There was no pneumo- ula. This is only the second reported case of a calcified bilia and the gallbladder was normal. On review of primary enterolith causing proximal SBO (2). prior radiographs, the calcified mass was not definitely discernable on the plain films, but it was visible, though overlooked, on a prior CT exam. CASE REPORT The patient was initially treated conservatively with A 98-year-old woman presented with several weeks IV fluids, no oral intake and nasogastric tube suction. of nausea, vomiting, abdominal pain and anorexia. After several days, however, she developed increased This was her third admission in the past month abdominal pain and absent bowel sounds. Exploratory for these complaints. She had a history of diverticulo- laparoscopy was performed. Intra-operatively, a hard sis coli, dementia, arthritis, hypertension, ischemic non-mobile mass was palpated in the distal jejunum stroke and congestive heart failure. Her medications with dilated bowel proximally. The entire small bowel included ciprofloxacin, diltiazem, pantoprazole and was carefully inspected and no diverticula were identi- supplemental nutritional drinks. Her past surgeries fied. There were no hernias and the gallbladder and included an abdominal hernia repair and hysterectomy. (continued on page 52) 50 PRACTICAL GASTROENTEROLOGY • JANUARY 2006 Jejunal Obstruction Caused by a Calcified Enterolith A CASE TO REMEMBER (continued from page 50) lying, but the surrounding mucosa was normal and there was no underlying stricture or other small bowel pathol- ogy. The stone measured 4.5 × 3 × 3 cm and sectioning revealed multiple layers (Figures 3–4). Stone analysis showed miscellaneous material with an amorphous component containing bilious byproducts. After surgery, her symptoms resolved and she was able to tolerate oral intake. However, due to comor- bidities, advanced age and deconditioning, she had a lengthy hospital stay and was not discharged until 2 weeks later. DISCUSSION Enteroliths are divided into two groups: false Fig. 3. Intact stone measuring 4.5 × 3 × 3 cm. enteroliths and true enteroliths (3). False enteroliths (i.e. fecoliths, varnish stones, almond pits, fruit skins, oat stones, phytobezoars or trichobezoars, and foreign common bile duct were normal. The mass could not be bodies) are formed by clumping together and inspissa- “milked” in either direction, so approximately 2–3 cm tion of intestinal content (3–5). True enteroliths result of jejunum was resected on either side of the mass. from precipitation and deposition of substances from Pathology results of the resected small bowel revealed alimentary chime (3). Proximal small bowel enteroliths acute mucosal necrosis in the area where the stone was are usually composed of bile acids, while those in the Fig. 4. Sectioned stone revealing multiple layers. 52 PRACTICAL GASTROENTEROLOGY • JANUARY 2006 Jejunal Obstruction Caused by a Calcified Enterolith A CASE TO REMEMBER distal small bowel are mainly composed of calcium malignancy. Definitive treatment for enterolith- salts (1,3). Among true enteroliths with bilious com- induced SBO is surgical with most patients requiring position, primary enteroliths are formed in the small enterotomy or occasionally resection. Prognosis is bowel and secondary enteroliths (gallstones) are good if timely therapy is rendered, so the desire to formed in the gallbladder (1). establish a diagnosis must not delay treatment because Enterolith formation is thought to be secondary to patients with an unresolved SBO need surgery (laparo- hypomotility or stasis, although many conditions have tomy or laparoscopy) rather than a diagnosis (14). ■ been implicated (3,6,7). Small bowel diverticulosis is a well-established pre-disposing condition, where stones References form de novo or around a central nidus such as a fruit 1. Singleton JM. Calcific enterolith obstruction of the intestine. Brit stone or undigested vegetable matter (bezoar) (2). Since J Surg, 1970;57:234-236. 2. Hayee B, Khan HN, Al-Mishlab T, et al. A case of enterolith there were no small bowel diverticula in our case, we small bowel obstruction and jejunal diveticulosis. World J Gas- hypothesize that hypomotility or stasis—due to advanced troenterol, 2003;9:883-884. 3. Klinger PJ, Seelig MH, Floch NR, et al. Small intestinal age, immobility, and possibly diltiazem (8–10)—led to enteroliths: unusual cause of small intestinal obstruction: report the formation of the enterolith. Radiological diagnosis of of three cases. Dis Colon & Rectum, 1999;42:676-679. 4. Shocket E, Simon SA. Small bowel obstruction due to enterolith a primary enterolith is uncommon unless it is calcified, (bezoar) formed in a duodenal diverticulum: a case report and which usually only occurs in the more alkaline ileum (4). review of the literature. Am J Gastroenterol, 1982; 77:621-624. 5. Gupta SK, Shirbhate NC, Khanna NN, et al. Enterolithiasis. Conceivably, age-related hypochlorhydria and proton J Postgrad Med, 1982;28: 225-228. pump inhibition (pantoprazole) could have created an 6. Lopez PV, Welch JP. Enterolith intestinal obstruction owing to alkaline milieu in the proximal small bowel resulting in acquired and congenital diverticulosis: report of two cases and review of the literature. Dis Colon Rectum, 1991; 34:941-944. calcium deposition in the jejunum. 7. Coster DD, Mouw BD, Kollmorgen RL. Primary small intestinal Gallstone ileus, or SBO due to a gallstone (sec- enteroliths. Surg Rounds, 1991;7:623-624. 8. Mantzoros CS, Prabhu AS, Sowers JR. Paralytic ileus as a result ondary enterolith), occurs in about 1 in 200 patients of diltiazem treatment. J Intern Med, 1994;235:613-614. with cholelithiasis (11). The average age at presenta- 9. Fauville JP, Hantson P, Honore P, et al. Severe diltiazem poison- ing with intestinal pseudo-obstruction: case report and toxicolog- tion is 70, and it accounts for 25% of nonstrangulated ical data. J Toxicol Clin Toxicol, 1995;33: 273-277. SBO’s in those over 65 years of age (11,12). On the 10. Harada T, Ohtaki E, Sumiyoshi T, et al. Paralytic ileus induced by the combined use of nifedipine and diltiazem in the treatment other hand, there are fewer than 100 reported cases of of vasospastic angina. Cardiology, 2002;97:113-114. primary enteroliths causing SBO (6,13). While the 11. Reisner RM, Cohen JR. Gallstone ileus: A review of 1001 stone analysis in our case revealed an amorphous com- reported cases. Am Surg, 1994; 60:441-446. 12. Clavien PA, Richon J, Burgan S, et al. Gallstone ileus. Br J Surg, ponent containing bilious byproducts, the gallbladder 1990;77:737-742. and common bile duct were normal by CT and at 13. Yang HK, Fondacaro PF. Enterolith ileus: a rare complication of duodenal diverticula. Am J Gastroenterol, 1992;87:1846-1848. laparoscopy, which strengthens the evidence that our 14. Lobo DN, Braithwaite B, Fairbrother BJ. Enterolith Ileus Com- case was a primary enterolith. Therefore, given the plicating Jejunal Diverticulosis. J Clin Gastroenterol, 1999; absence of findings for gallstone ileus and the radio- 29:192-193. density and composition of the large amorphous stone, our case represents a calcified primary enterolith caus- ing proximal SBO. Only one other case of proximal SBO caused by a calcified enterolith has been reported PRACTICAL (2), but our case is unique due to the absence of small bowel diverticula.
Load more

Recommended publications
  • Meckel's Enterolith Causing Small Bowel Obstruction
    Open Access Case Report DOI: 10.7759/cureus.15934 Meckel’s Enterolith Causing Small Bowel Obstruction: A Useful Solution to a Unique Problem Gabriel De la Cruz Ku 1 , Erek Nelson 1 , Rolando Calderon 1 , Pouya Hemmati 1 , Brian Kim 2 1. General Surgery, Mayo Clinic, Rochester, USA 2. Trauma and Acute Care Surgery, Mayo Clinic, Rochester, USA Corresponding author: Brian Kim, [email protected] Abstract Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. Its course is usually benign but may also result in complications requiring surgical intervention. A diverticulum may also permit the removal of intraluminal objects without bowel resection and anastomosis. A woman in her 50s was found to have a mechanical small bowel obstruction secondary to an intraluminal mass within the terminal ileum. On exploration, an MD was encountered proximal to the mass. A diverticulectomy was performed after maneuvering the enterolith into the diverticulum. Meckel’s diverticulum with an associated enterolith is a rare cause of small bowel obstruction. Historic imaging may show long-standing stones in the bowel lumen and provide a diagnostic clue. Diverticulectomy may be performed to reduce the risks of small bowel resection and anastomosis. This technique can be used for other intraluminal objects requiring removal in the presence of an MD. Categories: General Surgery Keywords: meckel´s diverticulum, gastrointestinal obstruction, surgery general, surgical acute abdomen, diagnosis Introduction Meckel’s diverticulum (MD) is caused by the incomplete obliteration of the vitelline duct during the seventh to eighth week of gestation [1]. It is present in approximately two percent of the population.
    [Show full text]
  • Brief Reports Enteroliths in a Meckel's Diverticulum Mimicking Gallstone
    brief reports Enteroliths in a Meckel’s Diverticulum Mimicking Gallstone Ileus Peter G. Justus, MD, James J. Bergman, MD, and Thomas R. Reagan, MD Redmond, W ashington allstone ileus is a form of mechanical obstruction of pain. The recurring symptoms had a duration of several G the small intestine caused by a large gallstone that hours, each time culminating in severe distress lasting 10 has passed from the gallbladder to the intestine through to 15 minutes. Progressive fatigue and episodic anorexia acholecystoenteral fistula.1 This diagnosis is suspected in pursued. He denied fatty food intolerance, jaundice, vom­ patients with gallstones and symptoms or signs of inter­ iting, or a past history of gastrointestinal disease. The mittent small-bowel obstruction. family history and other personal history were unremark­ Meckel’s diverticulum, the most common malformation able. of the gastrointestinal tract, is found in about 2 percent On examination the patient was well nourished and in of individuals.2 Its rare clinical manifestations include in­ no acute distress. He was normotensive, afebrile, and testinal obstruction, ulceration, hemorrhage, intussus­ nonicteric. The abdomen was mildly distended, and there ception, and neoplasm. Such phenomena usually are not was mild tenderness to deep palpation of the right upper diagnosed preoperatively.3 Some 50 cases of enteroliths quadrant. No rebound or guarding was elicited, nor were occurring in a Meckel’s diverticulum have been reported.4 there masses noted. Rectal examination was negative, al­ This unusual finding occurs most often in men and can though some brown, guaiac-positive stool was recovered. present with lower abdominal pain, vomiting,5 rectal The remainder of the physical examination was within bleeding,6 anemia,7 or bowel obstruction.8 Radiographs normal limits.
    [Show full text]
  • Stone Ileus: an Unusual Presentation of Crohn's Disease
    Ma, et al. Int J Surg Res Pract 2016, 3:046 International Journal of Volume 3 | Issue 2 ISSN: 2378-3397 Surgery Research and Practice Case Report: Open Access Stone Ileus: An Unusual Presentation of Crohn’s Disease Charles Ma and H Tracy Davido Department of Critical Care and Acute Care Surgery, University of Minnesota Health, USA *Corresponding author: H Tracy Davido MD, Assistant Professor of Surgery, Department of Critical Care and Acute Care Surgery, University of Minnesota Health, 11-115A Phillips Wangensteen Building, 420 Delaware St. SE, MMC 195, Minneapolis, MN 55455, USA, Tel: 612-626-6441, E-mail: [email protected] Introduction Case Report Stone ileus, also known as enterolith ileus enterolithiaisis, is a rare A 67-year-old morbidly obese woman came to the emergency complication of cholelithiasis and an even rarer symptom of Crohn’s department at our institution with an upper respiratory infection, disease. Gallstone ileus is secondary to fistula formation between decreased appetite, and malaise. Her past medical history was the gallbladder and the gastrointestinal (GI) system. Enterolithiasis significant for an open cholecystectomy more than 30 years earlier. of Crohn’s disease is thought to arise from the stasis of succus She had no additional past surgical history or diagnoses. The initial within the small bowel eventually leading to stone formation and workup revealed acute renal failure, with significant electrolyte growth. Both gallstone ileus and enterolithiasis of Crohn’s disease abnormalities and dehydration. She underwent intravenous fluid can result in subsequent mechanical bowel obstruction. Gallstone resuscitation and electrolyte replacement in the Medical Intensive ileus accounts for 1% to 4% of mechanical bowel obstructions, with Care Unit; however, while hospitalized, she developed new-onset higher a incidence in women over age 60 [1].
    [Show full text]
  • Enterolith with Enterocolic Fistula: the Diagnostic Approach Reshama S
    Case Report Enterolith with Enterocolic Fistula: The Diagnostic Approach Reshama S. Salelkar, Rajesh T. Patil, Dileep P. Amonkar, Sanjay G. Sardessai1 ABSTRACT An enterolith is a mixed concretion formed in GIT, usually rare in humans. Primary enteroliths are formed Department of Surgery, Goa in small bowel, typically within a diverticulum and secondary enteroliths in gallbladder. This case report Medical College, 1Department of highlights the presence of an enterocolic fistula; probably a postradiotherapy complication; and an enterolith Radiology, Goa Medical College, without associated small bowel or colonic diverticuli. We have discussed the various diagnostic modalities Goa, India used to reach a preoperative diagnosis of this rare condition. Imaging plays an important role in the detection Address for correspondence: and management of acquired gastrointestinal fistulas. The more routine use of cross-sectional imaging Dr. Reshama Salelkar, (especially computed tomography and magnetic resonance imaging) has altered the standard sequence of Qtr. No. 6, Type 5 GMC Qtrs., radiologic evaluation for possible fistulas, but fluoroscopic studies remain a valuable complement, especially Opp. SBI Bambolim Branch, for confirming and defining the anomalous communications. GMC Staff Qtrs., Bambolim, Goa 403 202, India. Key Words: Enterolith, enterocolic fistula, imaging modalities E-mail: rsalelkar1@rediffmail. com Received 29.11.2010, Accepted 14.03.2011 How to cite this article: Salelkar RS, Patil RT, Amonkar DP, Sardessai SG. Enterolith with enterocolic fistula: The diagnostic approach. Saudi J Gastroenterol 2011;17:418-20. An enterolith is a mixed concretion formed in GIT, usually firm mobile lump was palpable in the left lumbar region. rare in humans. Enteroliths are of endogenous origin and Her hemoglobin and counts were normal.
    [Show full text]
  • Enterolithiasis in a 15 Year Old Dongola Breed Stallion
    Journal of Experimental Agriculture International 43(5): 1-6, 2021; Article no.JEAI.70913 ISSN: 2457-0591 (Past name: American Journal of Experimental Agriculture, Past ISSN: 2231-0606) Enterolithiasis in a 15 Year Old Dongola Breed Stallion D. O. Omoniwa1, B. A. Alaba2, R. O. Okeke3, W. A. Adanu4, J. J. Kalang1, O. O. Oladipo5 and R. A. M. Adedokun2 1Department of Veterinary Medicine, Surgery and Radiology, Faculty of Veterinary Medicine, University of Jos, Nigeria. 2Department of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria. 3Department of Animal Science, Ahmadu Bello University, Nigeria. 4Department of Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Jos, Nigeria. 5Biochemistry Division, National Veterinary Research Institute, Vom, Plateau State, Nigeria. Authors’ contributions This work was carried out in collaboration among all authors. All authors read and approved the final manuscript. Article Information DOI: 10.9734/JEAI/2021/v43i530683 Editor(s): (1) Prof. Rusu Teodor, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Romania. (2) Dr. Lixiang Cao, Sun Yat-sen University, China. Reviewers: (1) Amir Hossan Shaikat, Chattogram Veterinary and Animal Sciences University, Bangladesh. (2) Dhruv Desai, Navsari Agricultural University, India. Complete Peer review History: http://www.sdiarticle4.com/review-history/70913 Received 25 April 2021 Case Study Accepted 05 July 2021 Published 05 July 2021 ABSTRACT Equine enteroliths are mineral accumulations of magnesium-ammonium-phosphate (struvite) around a foreign object that form round, triangular, or flat stones inside the bowel usually over the course of multiple years. They form in the large colon of horses where they can remain for some time until they move and cause an obstruction in the large or small colon, resulting in colic.
    [Show full text]
  • Colic in Horses
    ��� ����������� Volume�� 26 No 1, January 2008 A Publication of the Center for Equine Health, UC Davis School of Veterinary Medicine Colic: An Age-Old Problem To make a perfect horseman, three things are requisite. First, to know how and when to help your horse. Secondly, how and when to correct him. And thirdly, how and when to praise him and to make much of him. —Thomas Blundeville n spite of all the progress made in equine medicine in Ithe last 30 years—signifi cant advances in abdominal surgery, post-operative treatment and intensive care for horses—colic is still considered the most common cause of death in adult horses and accounts for a large proportion of emergencies for horse owners and veterinarians. It has been reported that approximately 920,000 horses nationwide will suffer an episode of colic each year, and more than 64,000 horses will face potentially life-threatening problems due to colic. Another report cites the incidence of colic at about 11 cases for every 100 horses per year. These are signifi cant numbers, any way you look at them. the abdominal cavity. It is not a specifi c disease but rather a combination The word colic is a vague term that of signs that signal the presence of abdominal pain in horses. These signs indicates clinical signs of pain in can range from mild to severe and can rapidly become a life-threatening situation. The most common clinical signs easily noticeable to horse owners include: INSIDE THIS ISSUE… • Repeated turning of the head toward the fl ank Directorʼs Message .................
    [Show full text]
  • Diseases of the Stomach A
    DISEASES OF THE GASTROINTESTINAL TRACT (Notes Courtesy of Dr. L. Chris Sanchez, Equine Medicine) The objective of this section is to discuss major gastrointestinal disorders in the horse. Some of the disorders causing malabsorption will not be discussed in this section as they are covered in the “chronic weight loss” portion of this course. Most, if not all, references have been removed from the notes for the sake of brevity. I am more than happy to provide additional references for those of you with a specific interest. Some sections have been adapted from the GI section of Reed, Bayly, and Sellon, Equine Internal Medicine, 3rd Edition. OUTLINE 1. Diagnostic approach to colic in adult horses 2. Medical management of colic in adult horses 3. Diseases of the oral cavity 4. Diseases of the esophagus a. Esophageal obstruction b. Miscellaneous diseases of the esophagus 5. Diseases of the stomach a. Equine Gastric Ulcer Syndrome b. Other disorders of the stomach 6. Inflammatory conditions of the gastrointestinal tract a. Duodenitis-proximal jejunitis b. Miscellaneous inflammatory bowel disorders c. Acute colitis d. Chronic diarrhea e. Peritonitis 7. Appendices a. EGUS scoring system b. Enteral fluid solutions c. GI Formulary DIAGNOSTIC APPROACH TO COLIC IN ADULT HORSES The described approach to colic workup is based on the “10 P’s” of Dr. Al Merritt. While extremely hokey, it hits the highlights in an organized fashion. You can use whatever approach you want. But, find what works best for you then stick with it. 1. PAIN – degree, duration, and type 2. PULSE – rate and character 3.
    [Show full text]
  • Meckel's Enterolith : a Rare Cause of Mechanical Small Bowel
    534 CASE REPORT Meckel’s enterolith : a rare cause of mechanical small bowel subobstruction L. Wauters1, K. Peeters2, A. Van Hootegem3, P. Goetstouwers3, P. Delvaux2, J. Callens3 (1) Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium ; (2) Department of General Surgery, AZ Klina, Brasschaat, Belgium ; (3) Department of Gastroenterology, AZ Klina, Brasschaat, Belgium. Abstract hemorrhagic colitis with crypt abscesses on pathology. His last bowel movements the previous day were normal Meckel’s diverticulum is the most common congenital and he was recently admitted for similar abdominal gastrointestinal malformation and may present with bleeding, complaints with an episode of non-bloody diarrhea obstruction and diverticulitis. Symptomatic Meckel’s diverticulum is associated with age < 50 years, male gender, diverticular length occurring 48h after a barbecue. He was treated with > 2 cm and ectopic mucosa. Formation of enteroliths is a rare intravenous fluids, analgesia and peroral Azithromycin complication of Meckel’s diverticulum and the majority of stones 500mg O.D. for suspected Campylobacter enteritis. will remain in the diverticulum. Factors promoting enterolith formation through precipitation of calcium in the small intestinal However, stool cultures, Shiga toxin and parasite alkaline environment include stasis as well as diverticular examination with stool antigen tests were negative and anatomy and histology. Mechanical obstruction due to liberation he was discharged home on the second day. His wife also of enteroliths is even more rare and other mechanisms include intussusception, adhesions, volvulus and neoplasms. Visualization suffered from gastrointestinal (GI) symptoms and both of enteroliths on plain abdominal films is challenging because returned from holidays in Mallorca 3 weeks ago.
    [Show full text]
  • Enterolith–Presenting As Acute Intestinal Obstruction
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 3 Ver. V (Mar. 2015), PP 38-40 www.iosrjournals.org Enterolith–presenting as acute intestinal obstruction Dr. Dhruv Sharma1 , Dr. Parikshit Malhotra2 , Dr. Pradeep Goyal3 , Dr. S.S. Minhas4 1. Associate Professor, Department of Surgery, IGMC, SHIMLA, H.P.INDIA 2. Assistant Professor, Department of Surgery, IGMC, SHIMLA 3. Assistant Professor, Department of Surgery, MMMCH, SOLAN 4. Prof & Head, Department of Surgery, MMMCH, SOLAN I. Introduction Gallstone ileus is well described but enteroliths which rarely form within gastrointestinal tract, except in certain pathological conditions like Crohn’s disease or blind loop syndrome may some times cause intestinal obstruction. There are few reported cases of primary enteroliths causing small bowel obstruction. We report a rare case of a primary calcified enterolith causing ileal obstruction. II. Case Report A 60 years old female patient was admitted in emergency with three days history of intermittent severe colicky central abdominal pain with bouts of vomiting. Patient had not passed flatus and stool for the last three days. There was also history of similar episodes of intermittent colicky abdominal pain in the past 3 years though pain used to be less severe in intensity and was of shorter duration. There was no history of previous surgery and an medical therapy in the past. On examination there was slight central abdominal distension and bowel sounds were raised. Radiograph of abdomen showed distended small bowel loops with a faint radio opaque shadow in hypogastric region. Emergency ultrasound revealed liver , spleen and gall bladder to be normal with minimal free fluid in the pelvis.
    [Show full text]
  • A Case of Perforation of Meckel's Diverticulum with Enterolith
    Shimagaki et al. Surgical Case Reports (2020) 6:161 https://doi.org/10.1186/s40792-020-00926-6 CASE REPORT Open Access A case of perforation of Meckel’s diverticulum with enterolith Tomonari Shimagaki* , Kozo Konishi, Koto Kawata, Keitaro Edahiro, Makoto Edagawa, Tomoyoshi Takenaka, Takahiro Ohmine, Nao Kinjo, Shohei Yamaguchi, Takashi Maeda, Shinichi Tsutsui and Hiroyuki Matsuda Abstract Background: Perforation of Meckel’s diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel’s diverticulum with one enterolith, which could not be accurately diagnosed by preoperative computed tomography. Case presentation: A 16-year-old male patient with acute onset of severe abdominal pain and a localized muscle guarding in the right hypochondrium had a solitary stone detected in the right abdomen by radiography. Abdominal computed tomography revealed a saclike outpouching of the small intestine, which contained fluid levels and an enterolith, with a mesenteric inflammatory change in the right paraumbilical area. He was diagnosed with peritonitis due to appendicitis or Meckel’s diverticulitis with enterolith, and emergency operation was indicated. The perforated Meckel’s diverticulum was identified approximately 30 cm proximal to the ileocecal valve. The diverticulum was transected at the base and removed. The patient’s postoperative course was uneventful. Conclusions: It is crucial for clinicians to thoroughly examine patients and appropriately request investigations that consider perforation of Meckel’s diverticulum as a possible diagnosis to facilitate prompt treatment. Keywords: Meckel’s diverticulum, Perforation, Enterolith Background Case presentation The German anatomist Johann Friedrich Meckel first A 16-year-old male patient with no prior abdominal described the embryological and pathological features surgery presented to our department with 2 days of of Meckel’s diverticulum in 1809 [1].
    [Show full text]
  • SELF ASSESSMENT ANSWERS an Interesting Case of Small Bowel
    630 Postgrad Med J 2002;78:630–634 Postgrad Med J: first published as 10.1136/pmj.78.924.633 on 1 October 2002. Downloaded from 6 Shocket E, Simon SA. Small bowel obstuction SELF ASSESSMENT ANSWERS due to enterolith (bezoar formed in a duodenal diverticulum: a case report and review of the literature). Am J Gastroenterol An interesting case of the stomach or small bowel. Four types have 1982;77:621–4. been described based on their composition: 7 Frazzini VI, English WJ, Bashist B, et al. small bowel obstruction phytobezoars (containing fibre and cellulose), Small bowel obstruction due to phytobezoar formation within Meckel diverticulum: CT Q1: What is the diagnosis? trichobezoar, lactobezoars, and miscellaneous. The last group includes medications (hydro- findings. J Comput Assist Tomogr This is a case of mechanical small bowel 1996;20:390–2. scopic bulk laxatives, cholestyramine, non- 8 Maglinte DDT, Chernish SM, DeWesse R, et obstruction secondary to an enterolith/bezoar absorbable antacids, vitamin C tablets, and the likely source of which is jejunal diverticu- al. Acquired jejuno-ileal diverticular disease: Isocal tube feeds), parasites (Ascaris lumbri- subject review. Radiology 1986;158:577– losis 1–3 coides or roundworm), and synthetic fibre. A 80. Q2 : What is the differential case of carpet fibre bezoar forming at the site 9 Brettner A. Euphrat EJ. Radiological diagnosis? of a stapled intestinal anastamosis in a child significance of primary enterolithiasis. with pica has been described.3 In general, the Radiology 1970;94:283–8. This includes the various intraluminal causes formation of bezoars in the small intestine 10 Blake MP.
    [Show full text]
  • Epidemiological and Pathological Aspects of Noninfectious Diseases of the Gastrointestinal Tract in 114 Horses in Southern Brazil¹ Matheus V
    Pesq. Vet. Bras. 40(4):242-253, April 2020 DOI: 10.1590/1678-5150-PVB-6516 Original Article Livestock Diseases ISSN 0100-736X (Print) ISSN 1678-5150 (Online) PVB-6516 LD Epidemiological and pathological aspects of noninfectious diseases of the gastrointestinal tract in 114 horses in Southern Brazil¹ Matheus V. Bianchi², Paula R. Ribeiro², Alanna S. Stolf ², Marianna Bertolini², Cláudio J.M. Laisse2, Luciana Sonne2, David Driemeier2 and Saulo P. Pavarini²* ABSTRACT.- Bianchi M.V., Ribeiro P.R., Stolf A.S., Bertolini M., Laisse C.J.M., Sonne L., Driemeier D. & Pavarini S.P. 2020. Epidemiological and pathological aspects of noninfectious diseases of the gastrointestinal tract in 114 horses in Southern Brazil. Pesquisa Veterinária Brasileira 40(4):242-253. Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves 9090, Porto Alegre, RS 91540-000, Brazil. Título Original E-mail: [email protected] Equine colic is one of the most common cause of death in horses, but few studies have epidemiological and pathological features of noninfectious diseases of the gastrointestinal tract investigated specifically the conditions at the necropsy. This study aimed to describe the [Título traduzido]. horses from 2005 to 2017. During this period, 114 horses died of noninfectious diseases in horses. A retrospective study was conducted in search of cases of these diseases affecting Autores of the gastrointestinal tract, and the main causes were: primary gastric dilation (27/114), volvulus (27/114), enterolithiasis (20/114), rectal (colonic) perforation (15/114), gastric or cecocolonic impaction (10/114), incarcerations (6/114), intussusception (4/114), and others (5/114).
    [Show full text]