Enterolithiasis, refractory anemia, and strictures of Crohn's disease

In Crohn's disease, multiple areas of small bowel stenosis are relatively common, but there are only 11 reported cases with stenosis complicated by enterolithiasis. We describe three patients with multiple strictures, enterolithiasis, and refractory iron deficiency anemia. The chronic anemia was severe, requiring multiple transfusions in two patients. One patient developed a perforation, and a second had cancer within one of the saccular dilatations between strictures. Management of this stricture-enterolith-anemia triad requires removal of the enteroliths and correction of the strictures by strictureplasty and/or resection. If the operation of choice is strictureplasty, however, meticulous inspection and biopsy of each proposed site of enteroplasty is essential to rule out carcinoma.