A Case of Small Bowel Obstruction Caused by an Enterolith

Abstract

An 84-year-old woman experienced abdominal pain and vomiting. She was previously diagnosed as having small bowel obstruction and was transferred to our hospital for intensive examination and treatment. The CT showed a mass in the small intestine, which on an ultrasonogram showed high echoes；we thought that was caused by a foreign body. The small intestine on the proximal side of the foreign body was expanded, we diagnosed her as having small bowel obstruction caused by a foreign body in the intestinal tract. The symptoms did not improve by ileus tube placement, and the foreign body could not be removed by an enteroscope；thus, an operation was performed. The small intestine containing a foreign body was identified by a laparoscope, and a lithotomy was performed via a minilaparotomy through the umbilicus. The xanthochromic foreign body measured 3.5×3.0×2.5cm. Infrared spectrometry revealed the calculus to be a bile acid concretion, which we thought was an enterolith. The enterolith was visible in the duodenal diverticulum on a CT scan 6 months previously, but had disappeared when the small bowel obstruction occurred. The diagnosis was small bowel obstruction by an enterolith that fell from the duodenum into the small intestine.