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Shrestha N, Regmee S, Kharel A, Guragai M. Ileal perforation secondary to bowel obstruction caused by foreign body bezoar: A case report. Ann Med Surg (Lond) 2022; 82:104564. [PMID: 36268308 PMCID: PMC9577426 DOI: 10.1016/j.amsu.2022.104564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Foreign body bezoar is a relatively uncommon variant of bezoars leading to intestinal obstruction and perforation. These are caused by the ingestion of indigestible materials that gradually grow in size. Case presentation Following is the case of a young female patient with abdominal pain and distension which was associated with nausea, vomiting, and obstipation. Contrast-enhanced computed tomography of the abdomen showed dilated jejunal and ileal loops, and a tubular hypodense structure on terminal ileum. During surgery, we discovered intraluminal foreign bodies and ileal perforation proximal to the ileocecal valve. The findings were suggestive of obstruction and perforation of terminal ileum secondary to foreign body obstruction. The patient was managed successfully with ileocolic resection and anastomosis. Discussion Patients with bezoars can remain asymptomatic or present with features of bowel obstruction. These are usually discovered while performing radiological imaging for the evaluation of symptoms. Though mild to moderate cases of bezoars resolve with the treatment by chemical dissolution, surgeries should be performed in patients with foreign body bezoars and in whom complications have arose. Conclusion Ingested foreign body could lead to formation of a bezoar which may cause obstruction and perforation—the sequelae must be kept in mind while managing a patient. Foreign body bezoars are rare causes of bowel obstruction and perforation. High index of suspicion must be kept while evaluating patients with psychiatric illnesses. Radiology helps in identifying foreign body as the cause. Bezoars should be considered as one of the differentials of bowel obstruction when the exact etiology is unclear.
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Hirakawa Y, Shigyo H, Katagiri Y, Hashimoto K, Katsumoto M, Tomoeda H, Nakano M. Nontraumatic perforation of the small intestine caused by true primary enteroliths associated with radiation enteritis: a case report. Surg Case Rep 2021; 7:102. [PMID: 33891220 PMCID: PMC8065084 DOI: 10.1186/s40792-021-01182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background True primary enterolithiasis is an uncommon condition, and nontraumatic perforation of the small intestine (NTPSI) is also an unusual entity. Therefore, NTPSI due to true primary enteroliths is an exceptionally rare complication. Moreover, enterolithiasis and radiation enteritis are also unique combinations. Herein, we present an exceedingly rare case of NTPSI induced by multiple true primary enteroliths associated with radiation enteritis. Case presentation A 92-year-old woman with acute abdominal pain was transferred to our hospital because a computed tomography (CT) scan performed by her family doctor revealed free air and fluid collection within her abdomen. Our initial diagnosis was upper gastrointestinal perforation, and we selected nonoperative management (NOM) with adnominal drainage. Although her general condition was stable, jejunal juice was drained continuously. Given that the CT performed 10 days after onset demonstrated perforation of the small intestine and adjacent concretion, we performed an emergency partial resection of the small intestine and jejunostomy. The resected bowel was 1 m in length and had many strictures that contained multiple enteroliths in their proximal lumens. The patient’s postoperative course was uneventful. The enteroliths were composed of deoxycholic acid (DCA). She was diagnosed with peritonitis due to NTPSI derived from multiple true primary enteroliths associated with radiation enteritis, as she had previously undergone hysterectomy and subsequent internal radiation therapy. Conclusions Clinicians should consider the rare entity of true primary enteroliths associated with radiation enteritis in NTPSI cases with unknown etiologies.
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Affiliation(s)
- Yusuke Hirakawa
- Department of Surgery, Chikugo City Hospital, 917-1 Izumi, Chikugo, Fukuoka, 833-0011, Japan.
| | - Hirona Shigyo
- Department of Surgery, Chikugo City Hospital, 917-1 Izumi, Chikugo, Fukuoka, 833-0011, Japan
| | - Yuriko Katagiri
- Department of Surgery, Chikugo City Hospital, 917-1 Izumi, Chikugo, Fukuoka, 833-0011, Japan
| | - Kazuaki Hashimoto
- Department of Surgery, Chikugo City Hospital, 917-1 Izumi, Chikugo, Fukuoka, 833-0011, Japan
| | - Mitsuru Katsumoto
- Department of Surgery, Chikugo City Hospital, 917-1 Izumi, Chikugo, Fukuoka, 833-0011, Japan
| | - Hiroshi Tomoeda
- Department of Surgery, Chikugo City Hospital, 917-1 Izumi, Chikugo, Fukuoka, 833-0011, Japan
| | - Masahiko Nakano
- Department of Surgery, Chikugo City Hospital, 917-1 Izumi, Chikugo, Fukuoka, 833-0011, Japan
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Komaki Y, Kanmura S, Tanaka A, Nakashima M, Komaki F, Iwaya H, Arima S, Sasaki F, Nasu Y, Tanoue S, Hashimoto S, Ido A. Cola Dissolution Therapy via Ileus Tube Was Effective for Ileus Secondary to Small Bowel Obstruction Induced by an Enterolith. Intern Med 2019; 58:2473-2478. [PMID: 31118399 PMCID: PMC6761349 DOI: 10.2169/internalmedicine.2745-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An 87-year-old bedridden woman developed intestinal obstruction caused by an enterolith or bezoar. Since the patient refused surgery, we administered 1,000 mL/day of cola via an ileus tube to dissolve the stone. Occlusion of the small intestine disappeared on day 6. The excreted stones contained calcium phosphate, which is typical of enteroliths. We later confirmed that the retrieved stones could be dissolved in cola (Coca-Cola®, pH 1.9) as well as 0.10 and 0.010 mol/L hydrochloric acid (pH 1.0 and 2.0, respectively) and food-grade vinegar (pH 2.6). These findings suggest that the enteroliths were dissolved by an acid-base reaction.
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Affiliation(s)
- Yuga Komaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Akihito Tanaka
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Mari Nakashima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Fukiko Komaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Hiromichi Iwaya
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Yuichiro Nasu
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shiroh Tanoue
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
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Daneel L, Kariappa S. Migrating faecolith: an unusual case of small bowel obstruction. ANZ J Surg 2018; 89:E456-E457. [PMID: 30208506 DOI: 10.1111/ans.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Lauren Daneel
- Department of Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Sanjay Kariappa
- Department of Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
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Sato K, Banshodani M, Nishihara M, Nambu J, Kawaguchi Y, Shimamoto F, Sugino K, Ohdan H. Afferent loop obstruction with obstructive jaundice and ileus due to an enterolith after distal gastrectomy: A case report. Int J Surg Case Rep 2018; 50:9-12. [PMID: 30064120 PMCID: PMC6077837 DOI: 10.1016/j.ijscr.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/10/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Afferent loop obstruction is an uncommon complication associated with Billroth II reconstruction or Roux-en-Y reconstruction after gastrectomy. Moreover, cases where the obstruction is caused by enterolith are rare. Here, we report a rare case of afferent loop obstruction caused by an enterolith after Roux-en-Y reconstruction of gastrectomy; subsequently, leading to ileus in the ileum. PRESENTATION OF CASE An 84-year-old man who received a Roux-en-Y distal gastrectomy for gastric cancer presented with symptoms of fever and jaundice 14 months later. Computed tomography (CT) scan revealed an enterolith in the duodenal afferent loop and a dilated intrahepatic bile duct. Although the obstructive jaundice and fever disappeared with conservative therapy, ileus occurred due to the movement of the enterolith into the ileum, which was refractory to conservative therapy. Therefore, enterotomy was performed to remove the enterolith, and the patient had an uneventful recovery. Histologically, the enterolith derived from food residue. No postsurgical sign of recurrence has been noted for 6 months. CONCLUSION We report a rare case where an enterolith in a duodenal afferent loop after distal gastrectomy led to obstructive jaundice, and subsequently, caused ileus by its movement into the ileum.
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Affiliation(s)
- Koki Sato
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Banshodani
- Department of Artificial Organs, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
| | - Masahiro Nishihara
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Junko Nambu
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Yasuo Kawaguchi
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Fumio Shimamoto
- Department of Pathology, Faculty of Health Sciences, Hiroshima Shudo University, Hiroshima, Japan
| | - Keizo Sugino
- Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hoskin S, MacKenzie D, Osman M, Oliphant R. Enterolithiasis as a complication of a jejunal diverticulum: an unusual case of small bowel obstruction. ANZ J Surg 2017; 89:E156-E157. [PMID: 28834105 DOI: 10.1111/ans.14150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 06/17/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Scott Hoskin
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
| | - Douglas MacKenzie
- Department of Surgery, University Hospital Crosshouse, Kilmarnock, UK
| | - Monzir Osman
- Department of Surgery, University Hospital Crosshouse, Kilmarnock, UK
| | - Raymond Oliphant
- Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia
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Recurrent Enterolithiasis Small Bowel Obstruction: A Case Seldom Described. Case Rep Gastrointest Med 2017; 2017:4684182. [PMID: 28589045 PMCID: PMC5446856 DOI: 10.1155/2017/4684182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/20/2017] [Indexed: 12/16/2022] Open
Abstract
Background Enterolithiasis of the small bowel is a rare phenomenon in humans although it has been frequently described in equines. Primary enteroliths have been described including those occurring secondary to conditions like Crohn's disease, small bowel diverticula, tuberculous or postoperative strictures, and blind loops but those occurring in an otherwise normal gut are exceedingly rare. Of even greater rarity is a recurrent small bowel enterolith presenting with obstruction. This may be the first report of such kind. Case Presentation A 70-year-old man undergoing treatment for stable alcoholic liver disease presented to the emergency with gradually progressive diffuse abdominal pain associated with vomiting and constipation for 7 days. He had gaseous abdominal distention but was not obstipated. He had a history of 2 laparotomies in the past for small bowel obstruction secondary to enterolith impaction. He was initially managed conservatively but since there was no significant clinical improvement, he underwent an exploratory laparotomy. A recurrent enterolith 5 × 5 cm in size was found impacted in the mid ileum with multiple dense serosal adhesions and bands. Adhesiolysis and enterotomy with removal of enterolith were performed. Conclusion Recurrent enterolithiasis of the small bowel is a rare phenomenon and may present with recurrent obstruction. Definitive preoperative diagnosis is not always possible and a high index of suspicion is required to avoid table misdiagnosis. Surgery is the mainstay of treatment once conservative measures fail. Laparoscopic methods may help in diagnosis and avoid possibility of a subsequent adhesive bowel obstruction but are associated with technical challenges.
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Raza MH, Finan R, Akhtar S, Ahmad M. Primary Enterolith in a Patient with Intestinal Tuberculosis: A Case Report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:552-556. [PMID: 27853338 PMCID: PMC5106573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary enterolithiasis is a rare surgical ailment. The underlying cause is intestinal stasis. Numerous anatomical and micro environmental factors such as enteritis, incarcerated hernia, malignancy, diverticula, blind loops, and enteroenterostomy predispose to clinically significant concretions. Enterolithiasis in tuberculosis can be due to the presence of strictures, intestinal bands, or interbowel/parietal adhesions, leading to intestinal stasis. Secondary enterolithiasis is generally caused by gallstones or renal stones migrating to the gastrointestinal tract due to fistula formation. During stasis, food particles act as a nidus and calcium salts are deposited over the food particles, leading to stone formation. A 57-year-old male patient presented to the Emergency Department of Jawaharlal Nehru Medical College, AMU, Aligarh, with features of intestinal obstruction. The patient underwent emergency laparotomy, revealing 2 strictures in the distal ileum with 15.24cm of the bowel between them containing a 2×2 cm enterolith. The strictured segment was resected, and end ileostomy and mucus fistula were created. The patient's postoperative recovery was fine, and he wasdischarged with ileostomy on antitubercular treatment (after histopathologicalconfirmation). Ileostomy closure wasplanned after 6 weeks. The incidence and prevalence of enterolithiasis has been on the rise recently because of advancement in radiological imaging studies. Endoscopic and surgical stone removal along with the treatment of the underlying pathology is recommended.
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Affiliation(s)
- Mohd. Habib Raza
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India,Correspondence: Mohd. Habib Raza, MS; Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, 202002, India Tel: +91 98 97879748
| | - RafiulImad Finan
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Sadik Akhtar
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Manzoor Ahmad
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
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Primarily Proximal Jejunal Stone Causing Enterolith Ileus in a Patient without Evidence of Cholecystoenteric Fistula or Jejunal Diverticulosis. Case Rep Surg 2016; 2016:8390724. [PMID: 27803836 PMCID: PMC5075608 DOI: 10.1155/2016/8390724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/20/2016] [Indexed: 01/27/2023] Open
Abstract
Stone formation within the intestinal lumen is called enterolith. This stone can encroach into the lumen causing obstruction and surgical emergency. Jejunal obstruction by an enterolith is a very rare entity and often missed preoperatively. To our knowledge, most cases of jejunal obstruction, secondary to stone, were associated with biliary disease (cholecystoenteric fistula), bezoar, jejunal diverticulosis, or foreign body. Hereby we present a rare case report of small bowel obstruction in an elderly man who was diagnosed lately to have primary proximal jejunal obstruction by an enterolith without evidence of a cholecystoenteric fistula or jejunal diverticulosis. This patient underwent laparotomy, enterotomy with stone extraction, and subsequent primary repair of the bowel.
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Winters L, Krell RW, Machado-Aranda D. Abdominal pain and faeculent vomiting in a 64-year-old woman. BMJ Case Rep 2016; 2016:bcr-2015-212826. [PMID: 26729826 DOI: 10.1136/bcr-2015-212826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 64-year-old woman with a previous right colectomy presented with severe epigastric abdominal pain and nausea of several weeks' duration, which then escalated to projectile faeculent emesis. During her clinical course, she remained afebrile with normal vital signs. Physical examination revealed abdominal distension, moderate tenderness in the bilateral upper quadrants and provoked voluntary abdominal wall guarding. Haematology and laboratory chemistries were only notable for a mild (14.6 K/μL) leucocytosis. Acute abdominal plain radiological series revealed dilated small bowel loops and possible pneumoperitoneum. Abdominal CT demonstrated a mechanical small bowel obstruction and no extraluminal air. An exploratory laparotomy was performed, revealing an obstructing enterolith related to actively inflamed jejunal diverticulitis (complicated JD). This case report aims to describe the non-specific presentation of a poorly understood disease entity that presents a diagnostic and therapeutic challenge for the medical community.
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Affiliation(s)
- Leigha Winters
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert W Krell
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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