Figure - available from: Case Reports in Surgery
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Contrast-enhanced computed tomographic image showing dilated jejunal loop (up to 5 cm in diameter) with a large calcified ring (black arrow).
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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...
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Key Clinical Message
Intravesical textiloma is a rare surgical complication, that may cause nonspecific lower urinary tract symptoms. Clinicians should consider it in patients with a history of bladder surgery and persistent or new‐onset urinary symptoms.
Abstract
Intravesical textiloma is a rare condition usually presents asymptomatic or with non...
Citations
... Primary enterolith formation in the duodenum and small bowel is rare and is usually associated with conditions such as diverticular disease, strictures, previous surgery, and chronic inflammation, that cause decreased motility and accumulation of certain matters leading eventually to stone or fragments formation [1,2]. In addition gallbladder or bile duct and renal tract fistulas are causes of secondary enteroliths when a stone(s) that has formed in a different organ migrates to the duodenum or small bowel. ...
... Imaging revealed a small bowel obstruction with evidence of a 3x4 cm foreign body in the distal jejunum causing upstream dilatation ( Figure 1). 1 2 2 2 1 ...
... Similar to our case, the formation of primary enterolith or stone material inside the small bowel without any precipitating factor has been reported in the past, however, the mechanism remains unclear [1,6,7]. In one case the enterolith contained uric acid but again without any association with any other anatomical, functional or biochemical abnormality (e.g hyperuricemia) [7]. ...
Enterolith formation is a rare condition precipitated by decreased bowel motility. It may cause obstruction or other complications and the diagnosis usually is confirmed after surgery and analysis of the stones or fragments. It is often seen in association with intestinal abnormalities such as diverticula and inflammation or in biliary tract fistulas where stones migrate to the duodenum and small bowel. We report an unusual case of a primary true enterolith formation in a patient without any underlying bowel condition or any previous surgery.
... SIBO occurs when the flow of intraluminal contents is disrupted, causing the proximal loops to dilate and the distal loops to decompress. 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. ...
Background
To evaluate the clinical characteristics and indications for surgery for bezoar-induced small bowel obstruction (BI-SBO).
Methods
Forty patients with BI-SBO were treated at our hospital from January 2017 to December 2019, and these patients’ clinical and computed tomography (CT) data were analyzed.
Results
Twenty-seven and 13 BI-SBO patients constituted the non-ST group and ST group, respectively. The clinical manifestations of BI-SBO in both groups were abdominal pain, nausea, vomiting, and lack of defecation. Comparing the non-ST vs ST groups, respectively: mean age (years): 63.15 ± 16.15 vs 60.38 ± 12.47; duration of symptoms (hours): 55.11 ± 44.08 vs 59.33 ± 72.90; mean bezoar length (cm): 5.31 ± 0.74 vs 3.72 ± 0.53; mean bezoar width (cm): 3.74 ± 0.48 vs 2.9 ± 0.64; bezoar CT maximum Hounsfield units (HU): 97.23 ± 12.36 vs 21.11 ± 7.27; total hospital stay (days): 5.56 ± 4.23 vs 7.12 ± 6.12 (mean: 8.62 ± 2.81); and total hospitalization costs (RMB): 6378.02 ± 3015.68 vs 8213.71 ± 5564.29. Mean operation time was 85.00 ± 8.90 minutes, and mean operation blood loss was 32.31 ± 19.64 mL. Bezoars were located 60 to 160 cm from the ileocecal junction. Univariate analysis demonstrated that bezoar length and width and maximum CT value were significant risk factors for surgery.
Conclusion
Large bezoar size and high CT values may be indications for surgery. Surgery is necessary and effective when nonsurgical treatment is ineffective.
... It is generally accepted that the production of enteroliths is favoured by states of intestinal dysmotility, especially in cases of duodenal or jejunal diverticulosis. Mostly composed of choleic acid and other bile metabolism products, these stones tend to have similar CT features of gallstone, being usually calcified and round-shaped [24]. Absence of biliary-enteric fistula and normal appearance of the gallbladder may suggest the diagnosis. ...
Gallstone ileus is a dramatic complication of gallstone disease, uncommon but not exceptional in a busy emergency department. It represents a cause of mechanical intestinal obstruction, which predominantly occurs in elderly and frail patients; this contributes to the high morbidity and mortality rates associated with this condition. The modern radiologist is frequently asked to determine the cause of bowel obstruction and should be aware of the most pictorial features of this unusual disease. Broadly speaking, abdominal radiography and ultrasonography alone are limited in detecting the cause of bowel obstruction, but the sensitivity for the preoperative diagnosis of gallstone ileus may be improved by combining the findings obtained by both techniques. Computed tomography is the modality of choice for the diagnosis of this disease: it may accurately describe the number, size, and location of migrated gallstones and the exact site of bowel obstruction, providing a detailed preoperative planning. Magnetic resonance imaging may be used in selected cases for an exquisite anatomic definition of the fistulous communication.
... 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). ...
... 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. ...
An 87-year-old bedridden woman developed intestinal obstruction caused by an enterolith or bezoar. Since the patient refused surgery, we administered 1,000 mL/day of cola via an ileus tube to dissolve the stone. Occlusion of the small intestine disappeared on day 6. The excreted stones contained calcium phosphate, which is typical of enteroliths. We later confirmed that the retrieved stones could be dissolved in cola (Coca-Cola®, pH 1.9) as well as 0.10 and 0.010 mol/L hydrochloric acid (pH 1.0 and 2.0, respectively) and food-grade vinegar (pH 2.6). These findings suggest that the enteroliths were dissolved by an acid-base reaction.
... Chomelin J, a french surgeon early in XVIII century, as a case of stone formation in a duodenal diverticulum at autopsy [5]. Sjoqvist gave the chemical composition of an enterolith early in the XXth century [6], more recently Pfahler., et al. published a report on the radiological features of enterolithiasis [11] and it was not until 1959 that Atwell., et al. introduced the definition of enteroliths as "endogenous foreign bodies in the gastrointestinal tract" [8,12]. Its prevalence ranges from 0.3% to 10% in selected populations [13,15]. ...
Introduction. Small bowel obstruction can be caused by an enterolith formed within a jejunal diverticulum. Cases. We report two patients with obstructive acute abdomen caused by jejunal enteroliths, demonstrated by CT-Scan, and treated by local jejunal resection and respective mechanical anastomosis by laparoscopic surgery. No evidence of fistula to the small bowel was evidenced. In both cases post-operative follow-up was uneventful. Analysis of the stones revealed the presence of calcium oxalate and bile pigments. Conclusions. It is well accepted that diverticula provide an acidic environment necessary for choleic acid precipitation and stone formation. However, calcification cannot occur without an alkaline pH shift, which normally occurs in the ileum. Our cases confirm calcification occurring in the proximal small bowel. Discussion. Consensus management of enterolith ileus is to remove the stone through an enterotomy which is made in a less oedematous segment of the jejunum or by a small bowel segmentary resection done by laparoscopy.
Key words : entherolith, bowel obstruction, jejunal diverticulum, laparoscopy
... 8 In very rare cases cholecystoenteric fistulas are absent as in the case we have reported. 9 Surgical treatment of large stones is still controversial; current surgical procedures are simple enterolithotomy or enterolithotomy, cholecystectomy and fistula closure in a onestage procedure or enterolithotomy with cholecystectomy performed later; bowel resection may be necessary in certain cases after enterolithotomy is performed. 2,10 In recent years, in cases of stones located in the jejunum or in the colon, endoscopic treatment with extraction of the stone may be carried out with or without extracorporeal shock wave lithotripsy to fragment the stones. ...
Gallstone ileus is a rare form of mechanical intestinal obstruction caused by the passage of gallstones in the gastroin-testinal lumen and is often diagnosed in elderly females. Diagnosis can be difficult due to nonspecific findings during physical examination and there are a number of options regarding surgical or endoscopic treatment. We report the rare case of a 77-year-old female patient with gastrointestinal obstruction due to a gallstone, but without a cholecystointestinal fistula. Clinicians should be aware of this rare entity especially in emergency situations, as early diagnosis and appropriate subsequent therapy in such cases is essential to reduce mortality.
A 60-year-old woman was presented in emergency department with abdominal pain and vomiting for 1 day. She was known to have seropositive rheumatoid arthritis. Importantly, she was treated surgically for complex jejunal atresia and duplication surgery, when she was 6 days old. CT scan showed intestinal obstruction secondary to intussception. Patient had lapartomy and operative findings revealed side-to-side anastomosis with gut duplication 10 cm distal to duodenal jejunum junction (due to her previous surgery during infancy). Redundant part of the loop dilated up to 300 mL with large hard stone (4×3.5 cm) was excised. Patient recovered well postoperatively and was discharged to go home. To our knowledge, this is the first case report to show formation of large stone 60 years after surgical treatment of complex jejunal atresia and duplication surgery in infancy.
