Enterolithiasis in a Patient With Prior Bowel Resection.

Enterolithiasis is the development of intestinal stones, thought to be related to conditions that predispose to stasis and stricture of the intestines and disruption of chemical factors such as pH. It has been described in the setting of inflammatory bowel disease, intestinal tuberculosis, and prior surgery of the bowel. Our patient was a 68-year-old Caucasian female with prior bowel resection secondary to hernia repair who presented many years later with obstructive symptoms including abdominal pain, nausea and vomiting, and ultimately inability to tolerate oral intake. Initial CT scans showed nonspecific inflammation and dilation of a segment of the small bowel, unable to rule out infectious or neoplastic process, and retained fecal material. The patient was initially managed conservatively with antiemetics, antibiotics, and bowel rest. After worsening of symptoms, the patient was readmitted, and exploratory laparotomy was performed during which a mesenteric mass was discovered adjacent to an area of conglomerated bowel which contained intraluminal rock-like material. After partial bowel resection and side-by-side anastomosis, the patient showed complete clinical recovery. Emphasis is placed on the importance of considering this uncommon etiology in the differential diagnosis of obstructive symptoms. Delayed diagnosis may lead to untoward complications such as perforation, and further understanding of the pathology may lead to increased detection and earlier intervention with surgical or endoscopic management.