A Case of True Enteroliths due to Small Intestinal Anastomotic Stenosis with Repeated Intestinal Obstruction

Abstract

A 45-year-old man had previously undergone two laparotomies at other hospitals. Since then, he had frequently developed intestinal obstruction and had been treated conservatively. Abdominal computed tomography at the onset of intestinal obstruction showed marked dilatation of the intestinal tract on the oral side from the anastomosis of the small intestine, and many flattened foreign bodies were observed inside the anastomosis. Laparoscopy showed that the small intestinal anastomosis adhered to the abdominal wall and served as the starting point of the intestinal obstruction. The adhesions were removed, and the small intestine including the anastomosis was partially resected. The anastomosis was found to show saccular dilatation on the oral side with scar stenosis, and many stones were found inside the anastomosis. These stones were the true enteroliths made of deoxycholic acid. The patient had a good postoperative course and was discharged on the sixth postoperative day.

In this case, the intestinal fluid stagnated due to saccular dilatation at the functional end-to-end anastomosis resulting from postoperative anastomotic stenosis, and true enteroliths were considered to have formed. Reports of true enteroliths caused by gastrointestinal anastomosis are rare, and this case is reported along with a review of the literature.