A 53-year-old woman with a 2-year history of intermittent abdominal pain, diarrhea, and constipation presented for evaluation. Her medical history was significant for congenital imperforate anus requiring a colostomy at birth with reanastomosis at the age of 2 years. Radiography (Panel A) and computed tomography (Panel B) of the upper gastrointestinal tract showed filling defects (arrows in both panels) and a small bowel stricture (arrowhead in Panel A). During surgical exploration, it was noted that 20 cm of ileum was inflamed, with two diverticuli containing multiple stones and an associated stricture (Panel C, arrow). This portion of the ileum was resected, and pathological examination revealed primary small-bowel enterolithiasis associated with stricture. The patient had complete resolution of symptoms in the postoperative period.
Primary small-bowel enterolithiasis is a rare disease associated with intestinal inflammation and stricture. Common causes are inflammatory bowel disease and adhesions. Multiple stones may form within diverticuli in the small bowel. Treatment is similar to that for small-bowel obstruction, with surgery indicated if nonoperative management fails.
Wroblewski and Sticca NEJM 359 (12): 1271, Figure 1 September 18, 2008
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