Conservative Management Enabling Spontaneous Passage of an Idiopathic Primary Spontaneous Enterolith: A Case Report...

Enterolithiasis-formation of stone concretions within the gastrointestinal tract-is an uncommon and underrecognized cause of intermittent abdominal symptoms and acute bowel obstruction. Primary (true) enteroliths originate within the bowel lumen and are usually associated with focal stasis from anatomic or inflammatory pathology; idiopathic primary enterolithiasis (no identifiable predisposing lesion) is exceptionally rare. We present a case that illustrates diagnosis by contrast-enhanced CT and successful nonoperative management of extensive idiopathic enterolithiasis. A 52-year-old woman presented with a 2-month history of intermittent, crampy lower abdominal pain that increased in frequency over the week before presentation. She had no prior abdominal surgery, no history of inflammatory or ischemic bowel disease, and no systemic symptoms. On examination she was hemodynamically stable with a soft, non-tender abdomen and normal laboratory tests. Contrast-enhanced abdominal CT demonstrated numerous discrete intraluminal calcifications within the large bowel consistent with multiple enteroliths but no bowel dilatation, obstruction, perforation, or underlying stricture/diverticulum. Given the clinical stability and absence of obstructive complications, she was treated conservatively with bowel rest, intravenous (IV) isotonic fluids, and analgesia. Over the following days, her pain resolved, and she passed multiple firm, stone-like fragments per rectum. Compositional analysis of a retrieved specimen showed a predominance of calcium salts (calcium phosphate and calcium carbonate) with minor magnesium ammonium phosphate and calcium oxalate. She remained asymptomatic at the 2-month outpatient follow-up with no further intervention. In carefully selected, hemodynamically stable patients without evidence of complete obstruction or ischemia, conservative management (bowel rest, IV fluids, close observation) can permit spontaneous passage of even multiple enteroliths and avoid surgery. Contrast-enhanced CT is essential for diagnosis and assessment of complications, and thorough evaluation to exclude underlying causes is recommended to guide follow-up and prevent recurrence.