Recurrent small bowel obstruction secondary to jejunal diverticular enterolith: A case report

Small bowel diverticulosis is an uncommon condition which is usually asymptomatic and is discovered incidentally. One rare complication is enteroliths forming in the diverticula causing bowel obstruction. Only a few cases of such have been described in literature, and recurrence from this aetiology has not been reported previously. This case report outlines the management of a 68-year-old male who presented with recurrent small bowel obstruction secondary to jejunal diverticular enterolith impaction, seven months following a previous episode.

A 68-year-old male presented with symptoms of small bowel obstruction. Computed tomography (CT) of the abdomen demonstrated small bowel obstruction from an enterolith formed in one of his extensive jejunal diverticula. He required a laparotomy, an enterotomy proximal to the enterolith, removal of the enterolith, closure of the enterotomy, and resection of a segment of perforated ileum with stapled side-to-side anastomosis. Seven months later, he represented to emergency department with similar symptoms. Another CT scan of his abdomen revealed a recurrent small bowel obstruction secondary to enterolith impaction. He underwent another laparotomy in which it was evident that a large enterolith was impacted at the afferent limb of the previous small bowel anastomosis. A part of the anastomosis was excised to allow removal of the enterolith and the defect was closed with cutting linear stapler. In the following two years, the patient did not have a recurrent episode of enterolith-related bowel obstruction.

The pathophysiology underlying enterolith formation is unclear, so it is difficult to predict if or when enteroliths may form and cause bowel obstruction. More research could provide advice to prevent recurrent enterolith formation and its sequelae.