A Case of Intestinal Obstruction Caused by the Dropping of a True Enterolith Formed in a Duodenal Diverticulum

Abstract

A 65-year-old woman presented complaining of abdominal pain and vomiting. Computed tomography (CT) showed a foreign body in the upper jejunum, and intestinal obstruction due to this object was suspected. A gastric tube was inserted, and the patient's course was monitored. Since CT then showed that the object had moved toward the anus, enteroscopy was performed with the aim of observing it. An enterolith was seen in the jejunum 150 cm from the ligament of Treitz, and it was determined that this was the cause of the intestinal obstruction. However, it could not be crushed enteroscopically and it was therefore decided to perform surgery. When the abdomen was opened, the enterolith was found to be impacted at the site where it had been observed by enteroscopy, and enterotomy was performed to remove it. The enterolith measured 5.0×4.5×4.5 cm, and component analysis showed that it was a bile acid enterolith. The duodenal diverticulum had been identified previously, and a shadow thought to represent the enterolith had been evident within it on previous CT. This shadow in the duodenal diverticulum had disappeared on CT images scanned when the intestinal obstruction occurred, and the obstruction was therefore considered to be due to the enterolith having dropped. Although some cases of intestinal obstruction by a dropped enterolith have been reported, intestinal obstruction due to the dropping of a true enterolith formed in a duodenal diverticulum is extremely rare, and this case is reported together with a short discussion of the literature.