Chronic intestinal pseudo-obstruction complicated with sand-like enterolithiasis: case report

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Case Study

Background:

• Enterolithiasis is commonly linked to gastrointestinal stasis.
• Chronic intestinal pseudo-obstruction (CIPO) presents a significant clinical challenge.
• Sand-like enterolithiasis is an exceptionally rare manifestation of CIPO.

Purpose of the Study:

• To report a rare case of sand-like enterolithiasis in an 18-year-old female with CIPO.
• To investigate the composition and potential cause of the sand-like enteroliths.
• To highlight the management and implications of this condition.

Main Methods:

• Case report of an 18-year-old Japanese female with CIPO, fever, and abdominal pain.
• Diagnostic imaging including contrast-enhanced computed tomography (CECT).
• Endoscopic evaluation with colonoscopy for diagnosis and intervention, followed by infrared spectroscopy for enterolith analysis.

Main Results:

• The patient presented with high fever and abdominal pain, unresponsive to initial antibiotics.
• CECT revealed colonic enlargement and a high-density residue in the ascending colon.
• Colonoscopy identified and enabled drainage of sand-like enteroliths (<300 μm). Infrared spectroscopy suggested hydroxypropyl cellulose as a component.

Conclusions:

• Severe intestinal dysmotility, as seen in CIPO, can lead to sand-like enterolithiasis.
• Hydroxypropyl cellulose, an additive in medications, may play a role in enterolith formation.
• This condition, potentially linked to intestinal failure, necessitates careful monitoring and management.