Primary Enterolithiasis Associated With Severe Hypothyroidism and Ileal Stricture Presenting As Small Bowel Obstruction: A Case Report.

Enterolithiasis is an uncommon condition characterized by the formation of stones within the gastrointestinal tract and may rarely present as small bowel obstruction, typically developing in areas of intestinal stasis such as strictures, diverticula, or blind loops. Severe hypothyroidism can contribute to intestinal dysmotility and predispose to such stasis. We report a case of a 76-year-old woman who presented with abdominal pain, constipation, vomiting, and inability to pass stool or flatus for four days. Imaging demonstrated dilated small bowel loops with an intraluminal radio-opaque lesion consistent with an enterolith, and laboratory evaluation revealed severe primary hypothyroidism. An exploratory laparotomy identified an enterolith of size 2 x 3 cm in the proximal ileum just proximal to an ileal stricture. Enterotomy with stone extraction along with stricturoplasty was performed. The postoperative course was uneventful, and the patient was initiated on thyroid hormone replacement therapy. Severe hypothyroidism should be considered a potential contributory factor in enterolithiasis, and surgical intervention should address both the enterolith and the underlying stricture.