A Case of Intestinal Obstruction due to the Dislodgment of a True Enterolith Formed in a Duodenal Diverticulum

Abstract

An 82-year-old man, previously recurrence-free after laparoscopic resections for gastric and rectal cancers, presented with small bowel obstruction and was transported emergently to another hospital. He developed aspiration pneumonia and septic shock, requiring intensive care. Four weeks after onset, he was transferred to our hospital for further evaluation and treatment. Contrast-enhanced computed tomography (CT) and contrast through an ileus tube demonstrated a gas-containing intraluminal mass in the small bowel, consistent with obstruction due to an enterolith. With nutritional rehabilitation via enteral feeding, laparoscopic partial small bowel resection and enterostomy were performed. The extracted yellow enterolith measured 6.0 × 5.0 × 3.5 cm. A retrospective review of the CT obtained at onset and at transfer showed that a stone initially located within a duodenal diverticulum had disappeared by the time of obstruction, indicating drop and impaction as the mechanism. The patient's postoperative course was uneventful ; the patient resumed oral intake and was discharged about two months later. Although obstruction caused by a dropped enterolith has been reported, occlusion due to a dropped true enterolith formed within a duodenal diverticulum is extremely rare. This case is reported along with a brief review of the literature.