Abstract
A 47-year-old man with chief complaints of abdominal pain and vomiting was examined at our hospital. Plain CT scan of the abdomen revealed a calcified density 1.5 cm in diameter in the small intestine, with small-bowel dilatation and fluid retention, in the right lower quadrant. Small bowel obstruction was diagnosed and a ileus tube was thus inserted, after which the patient was hospitalized. Surgery was performed laparoscopically on day 4 after the tube insertion, and disclosed a thumb-sized Meckel's diverticulum accompanied by a ring-shaped stricture at its base contralateral to the mesenterium, located at 40 cm on the oral side from the terminal ileum. The tip of the diverticulum adhering to the cecum formed a loop in which the ileum was impacted, constituting an internal hernia and small bowel obstruction. The bowel obstruction was relieved by resection of the diverticulum at its base. Enterectomy was not performed. A stone 1.5 cm in diameter was found in the diverticular lumen. It was diagnosed as a true enterolith since analysis of the stone showed it to consist of 99% calcium oxalate. Pathological examination revealed the lesion to be a true diverticulum with no evidence of ectopic mucosa. Meckel's diverticulum complicated by a true enterolith is a rare disorder, and in the case reported herein, it was speculated that the stricture at the base of the diverticulum had caused stangnation and retention of intestinal juice, leading to stone formation.
