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Large Enterolith Complicating a Meckel Diverticulum Causing Obstructive Ileus in an Adolescent Male Patient
Constantinos Nastos1, Dimitrios Giannoulopoulos1, Ioannis Georgopoulos2
1Second Department of Surgery, National and Kapodistrian University of Athens, School of Medicine, Aretaieion University Hospital, Athens, Greece.
Abstract:
We present a unique case of a 16-year-old male patient who was eventually diagnosed with a large enterolith arising from a Meckel's diverticulum. The enterolith had caused intermittent intestinal symptoms for three years before resulting in small bowel obstruction requiring surgical intervention. Meckel's enterolith ileus is very rare with only few cases described in the literature. To our knowledge, this is only the second case of Meckel's enterolith which had caused intermittent symptoms over a period of time, before resulting in ileus, and the first case where the intermittent symptoms lasted several years before bowel obstruction. The patient had been evaluated with colonoscopy, computerized tomography (CT), and magnetic resonance imaging enterography (MRIE); a calcified pelvic mass had been found, but no further diagnosis other than calcification was established. The patient presented at our emergency department, with symptoms of obstructive ileus and underwent exploratory laparotomy, where a large enterolith arising from a Meckel's diverticulum (MD) was identified, causing the obstruction. A successful partial enterectomy, enterolith removal, and primary end-to-end anastomosis took place; the patient was permanently relieved from his long-standing symptoms. Consequently, complications of Meckel's diverticulum and enterolithiasis have to be included in the differential diagnosis of abdominal complaints.
Insights
A rare case of a large enterolith from a Meckel's diverticulum caused intermittent symptoms for years before leading to small bowel obstruction. Surgical removal provided complete symptom relief, highlighting the need to consider Meckel's diverticulum complications in abdominal complaints.
Area of Science:
- Gastroenterology
- Surgical Case Report
Background:
- Meckel's diverticulum is a congenital anomaly that can lead to various complications.
- Enteroliths, or calculus-like masses in the intestine, are rare complications of Meckel's diverticulum.
Observation:
- A 16-year-old male presented with a three-year history of intermittent abdominal symptoms.
- Previous investigations including CT and MRI enterography revealed a calcified pelvic mass but no definitive diagnosis.
- The patient developed acute small bowel obstruction due to an enterolith.
Findings:
- Exploratory laparotomy identified a large enterolith originating from a Meckel's diverticulum causing the obstruction.
- Surgical intervention involved partial enterectomy, enterolith removal, and primary anastomosis.
- The patient experienced complete and permanent relief from symptoms post-surgery.
Implications:
- This case underscores the importance of considering Meckel's diverticulum and enterolithiasis in the differential diagnosis of prolonged, intermittent abdominal symptoms and eventual bowel obstruction.
- Highlights the diagnostic challenges posed by calcified masses on imaging.
- Emphasizes the successful surgical management and long-term resolution of symptoms through prompt diagnosis and intervention.
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