A case of enterolith ileus as a rare complication of duodenal diverticula

Abstract

A 77-year-old woman presented with abdominal pain, nausea and vomiting. Abdominal x-ray and ultrasonography revealed some dilated loops of small bowel. The patient was admitted with the diagnosis of small bowel obstruction. Abdominal computed tomography revealed a partially calcified mass about 3 cm in diameter in the dilated small bowel loop, just to the left of the cavitas pelvis. Gastrographin contrast study of the ileus tube showed ileus of small bowel, and with a preoperative diagnosis of small bowel obstruction, a laparotomy was performed. At operation, an oval hard mass obstructing the ileum about 4 cm in diameter was palpated at 60 cm proximal to the terminal ileum. A partial ileoresection was done, and the mass was removed. A yellow-brown enterolith which measured 4.5×3.5×2.0 cm was extracted. Chemical analysis revealed that the enterolith contained mainly deoxycholic acid. Postoperatively, an upper gastrointestinal x-ray series and gastroscopy were performed that showed the presence of diverticula in the third part of the duodenum and enteroliths in each of them, and normalcy of the gallbladder. For the reasons mentioned above, the diagnosis of small bowel obstruction secondary to a duodenal diverticular enterolith was made.