Meckel's diverticulitis due to an obstructing enterolith: ultrasound and CT appearances

Acute abdomen due to Meckel's enterolith: Case report and review of the literature

Meckel's diverticulum is a rare condition with an incidence of 1-3% in general population. It is usually asymptomatic and is incidentally detected during laparotomy/laparoscopy. Enterolith formation within Meckel's diverticulum is even rarer. Herein, we present the diagnosis and management of a 50-year old patient with Meckel's diverticulum enterolith and discuss this rare condition based on the literature.

Enterolithiasis

Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis in the presence of the intestinal diverticula, surgical enteroanastomoses, blind pouches, afferent loops, incarcerated hernias, small intestinal tumors, intestinal kinking from intra-abdominal adhesions, and stenosing or stricturing Crohn’s disease and intestinal tuberculosis. Enterolithiasis is classified into primary and secondary types. Its prevalence ranges from 0.3% to 10% in selected populations. Proximal primary enteroliths are composed of choleic acid salts and distal enteroliths are calcified. Clinical presentation includes abdominal pains, distention, nausea, and vomiting of occasionally sudden but often fluctuating subacute nature which occurs as a result of the enterolith tumbling through the bowel lumen. Thorough history and physical exam coupled with radiologic imaging helps establish a diagnosis in a patient at risk. Complications include bowel obstruction, direct pressure injury to the intestinal mucosa, intestinal gangrene, intussusceptions, afferent loop syndrome, diverticulitis, iron deficiency anemia, gastrointestinal hemorrhage, and perforation. Mortality of primary enterolithiasis may reach 3% and secondary enterolithiasis 8%. Risk factors include poorly conditioned patients with significant obstruction and delay in diagnosis. Treatment relies on timely recognition of the disease and endoscopic or surgical intervention. With advents in new technology, improved outcome is expected for patients with enterolithiasis.

Perforation of Meckel's diverticulum with enteroliths

Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with enteroliths, which could be accurately diagnosed by the preoperative computed tomography (CT). A 46-year-old man with acute onset of severe abdominal pain, and a localized muscle guarding in the right hypochondrium, had a solitary stone detected in the right abdomen by the radiography. The abdominal CT revealed a saclike outpouching of the small intestine, containing air/fluid levels and an enterolith, with surrounding free air and mesenteric inflammatory change in the right paraumbilical area. He was diagnosed as the perforation of Meckel's diverticulum with enterolith, and the emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 90 cm proximal to the ileocecal valve. The diverticulum was transected at the base, and removed. The patient's postoperative course was uneventful. This case strongly suggested the ability of CT enterography to accurately diagnose pathologies involving the small intestine, such as the perforation of Meckel's diverticulum, which open premises for its use in the diagnosis of acute abdomen preoperatively.

Meckel's Diverticulitis Presenting with Abdominal Pain and Angina

Meckel's diverticulum is the most common congenital gastrointestinal anomaly, and 2-4% of patients with a Meckel's diverticulum will subsequently develop complications, including intestinal hemorrhage, intestinal obstruction, and diverticulitis. Meckel's diverticulitis is infrequently included in the differential diagnosis of abdominal pain in older adults. We present a case of Meckel's diverticulitis in a 74 year-old male who presented with non-specific abdominal pain and angina. Here, multi-detector computed tomography (MD-CT) imaging provided a pre-operative diagnosis of Meckel's diverticulitis. We then offer a review of the epidemiology, anatomy, radiologic findings, and differential diagnosis of Meckel's diverticulitis. This case presents coronal and sagittal MD-CT reconstructions of Meckel's diverticulitis that have yet to be well-described in the literature.

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.

Bowel obstruction caused by a Meckel's diverticulum enterolith: a case report and review of the literature

Meckel's diverticulum is the most common congenital gastrointestinal anomaly. It may infrequently cause bleeding, perforation, or rarely obstruction. Formation of enteroliths in the diverticulum is uncommon. We present a case of small bowel obstruction from an expelled enterolith.