Multifocal Enterolithiasis Associated With Appendicitis and Colonic Diverticulosis Mimicking Gallstone Ileus: A Case...

Enterolithiasis is an uncommon condition that can present with nonspecific symptoms and pose a diagnostic challenge when concomitant cholelithiasis suggests gallstone ileus. We report the case of a 58-year-old woman who presented with abdominal pain, vomiting, and obstipation, with computed tomography findings initially suggestive of gallstone ileus. Exploratory laparotomy revealed no small-bowel obstruction or obstructing calculus. Instead, multiple calculi were identified within the appendix, and additional calculi were found impacted within diverticula throughout the colon, consistent with multifocal enterolithiasis. Appendectomy was performed, and the diverticular calculi were reduced into the intestinal lumen. Cholecystectomy was deferred because the biliary anatomy could not be safely identified. Histopathological examination demonstrated acute fibrinopurulent appendicitis and periappendicitis despite the absence of evident macroscopic inflammation. This case illustrates an unusual multifocal distribution of enteroliths involving the appendix and multiple colonic diverticula in a patient with concomitant cholelithiasis. It underscores the importance of integrating radiological findings with systematic intraoperative exploration when differentiating enterolithiasis from gallstone ileus.