Small Bowel Obstruction Presumably Caused by a Falled Enterolith which was Formed in Paraduodenal Papillary Diverticulum—Report of a Case—

Abstract

A 78-year-old woman presented with abdominal pain and vomiting. A blood analysis showed an increase in the hepatobiliary enzyme. A CT revealed a tumorous shadow associated with air in the proximal small bowel. She was diagnosed with cholangitis and was admitted to our hospital. Endoscopic retrograde cholangiopancreatography (ERCP) did not reveal any biliary stones. An ileus tube was placed, but it failed to resolve the bowel obstruction. A review of the CT findings showed the tumor within the small bowel to have distally moved. We performed laparoscopic surgery with the diagnosis of dietary or enterolith-caused bowel obstruction on the 13^th hospital day. A spherical hard object was found in the small bowel and enterotomy disclosed the object to be a atone, so that the stone was removed and the small bowel was sutured to close. The stone was 3.0 × 2.0 cm in size. As the deoxycholic acid level was more than 98% in a chemical analysis, the diagnosis of bile acid enterolith was made. A CT detected a 3.0 × 2.0 cm paraduodenal papillary diverticulum, but biliary duodenostomy and cholecystoduodenal fistula were clinically abscent. We considered that her small bowel obstruction might be caused by a falled enterolis from a paraduodenal papillary divrticulum. Contrary to plenty of cases of intestinal obstruction caused by gallstones, there are few cases caused by falled enterolith.