An Unusual Cause of Small Bowel Obstruction: A Case Report

Abstract

Small bowel obstruction is a common surgical emergency. The common causes are adhesions, malignancies, and hernias. We present a rare case of small intestinal obstruction caused by an enterolith in the distal ileum in a patient with an apparently normal gut. A 59-year-old male who underwent gastrojejunostomy 15 years back presented with features of intestinal obstruction of five days' duration. After initial conservative management, the patient was taken up for laparotomy. An enterolith causing obstruction was found in the distal ileum, and it was crushed and milked into the colon. The patient made an uneventful recovery. The chyme crossing the ileum is usually liquid or semi-solid and hence luminal obstruction by the faecal bolus in the ileum is very unusual. In patients with previous gastric surgeries where the pylorus is bypassed, the solid food particles enter the small intestine and can form a bezoar. This patient was managed with laparotomy and milking of the stool bolus into the colon. Other treatment options include enterotomy or resection of the diseased bowel and removal of the enterolith. Small bowel obstruction due to an enterolith is very rare and can pose a diagnostic challenge.

Keywords: enterolith; enterotomy; intestinal obstruction; surgical emergency.

Figure 1. Oral contrast study showing multiple air-fluid levels

Figure 2. Dilated jejunal bowel loops on laparotomy

Figure 3. Intraluminal enterolith causing the intestinal obstruction