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

BACKGROUNDSmall 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. CASE SUMMARYA 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.CONCLUSIONThe 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.     

Perforated small bowel diverticulosis. Case report

Three patients who presented with perforated small bowel diverticulosis were healed by resection of the perforated segment and primary anastomosis. Clinical awareness of this disease may reduce the relatively high mortality reported by most authors.     

Surgical problems of jejunal diverticulosis.

During a 10 year period 13 patients underwent operations for complications of jejunal diverticulosis. Two had diverticulitis, 7 perforation due to inflammation, 2 haemorrhage, 1 obstruction and 1 chronic gastrointestinal symptoms due to a large solitary diverticulum. None of the patients had a correct preoperative diagnosis. Three patients were labelled psychoneurotic because investigations prior to their emergency operation failed to reveal an organic cause for their symptoms. Small bowel contrast examinations should be included in the investigation of chronic gastrointestinal symptoms of obscure origin. Two patients on follow-up developed chronic gastrointestinal symptoms which were treated successfully with broad spectrum antibiotics.     

Acute necrotizing pancreatitis complicating surgery for renovascular hypertension. Case report

Acute necrotizing pancreatitis is a rare complication of various types of surgery, with a few cases reported after aortic operations. Following renovascular surgery, severe acute pancreatitis developed in three (0.9%) of 332 patients, and was fatal in one case. Various etiologic possibilities are discussed.     

Acute intestinal obstruction complicating thyrotoxicosis

Internal fixation appears to me the method of choice in dealing with fractures of the neck of the femur and intertrochanteric fractures. Of the many methods advanced, the Martin two-screw application is preferred from the standpoint of simplicity and efficiency. It gives results comparable to those reported by the use of procedures more popular at present.To date the cases forming the basis of this presentation are eighty in number and in the hands of twelve surgeons. This attests to the possibility of general use of the procedure by men qualified in surgery though possessing no special qualifications in the field of bone work.My thanks are hereby expressed to those who have so kindly allowed consideration of their cases in this presentation. Also to Dr. J. C. Rodick and the staff of the x-ray Department of Touro Infirmary, and to Drs. Samuel and Bowie for their kindness and assistance in procuring x-rays.     

Subacute intestinal obstruction caused by true enterolith

Enterolith in the abdominal X-Ray of a patient is a rare finding. Enteroliths are seen in presence of diverticula, tuberculosis and they also sometimes resemble gall stone ileus. Stone formation in absence of these entities is a rare phenomenon, which makes this case a rare phenomenon too.     

Jejunal diverticulosis with perforation and peritonitis. Case report

Non-Meckelian diverticula of the jejunum and ileum are reported to occur in 0.3-4.6% of all autopsies. A case with the rare complication of perforation and peritonitis is reported. The perforated diverticulum, partly hidden by the mesenteric fat may be hard to detect. The condition should therefore be looked for specifically by the surgeon when laparotomy fails to disclose perforation in the usual locations.     

Perforated jejuneal diverticulosis. Case report and review of literature

Acquired (non-Meckel's) jejunoileal diverticulosis is an uncommon disease, generally characterised by vague and unspecific symptoms. This rare condition is mainly expressed as acute complications: gastrointestinal haemorrhage, mechanic obstruction of the small intestine or perforated diverticulum, requiring urgent surgical intervention. The authors report a case of this unusual clinical occurrence characterized by a picture of abdominal pain due to perforation of jejuneal diverticulum. The final etiological diagnosis was possible only during surgery.     

Intestinal obstruction by giant Meckel's diverticulum. Case report

Most cases of Meckel's diverticulum (MD) are asymptomatic and discovered by chance. Management of MD is controversial. The authors describe an exceptional case of intestinal obstruction caused by a giant MD in a patient who had previously undergone appendectomy. A review of the contradictory literature on this subject leads to the conclusion that careful consideration of clinical and morphological data (patient's age, ASA score, the surgical procedure to be performed, morphology and position of the MD, any fibrotic bands) is required before deciding whether or not to resect an asymptomatic MD.     

Shall bowel obstruction caused by phytobezoar. Case report

Bezoars are masses of indigestible material which form in the stomach. Their genesis depends on the kind of food ingested, on the presence of anomalies of the small bowel and on psychiatric disturbs. Phytobezoar rarely causes bowel obstruction and its most frequent location is the ileocecal valve. The risk increases in those patients who have undergone gastric surgery or present a reduced masticatory ability. Moreover, the genesis can be also caused by endocrine disorders.     

Odontoid fracture complicating Jaffe-Lichtenstein disease. Case report

The authors report the case of a 31-year-old man with polyostotic fibrous dysplasia who suffered a traumatic odontoid fracture in an area of a preexisting bone lesion. Conservative treatment was successfully performed. Jaffe-Lichtenstein disease is discussed along with differential diagnoses and alternative methods of treatment.     

Portal hypertension complicating abdominal tuberculosis. Case report

Two cases of abdominal tuberculosis complicated by portal hypertension are reported. Both presented with haematemesis, melaena, night sweats, anorexia and weight loss. Tuberculous lymph nodes at the porta hepatis compressed the portal vein in one case, and the other had disseminated tuberculosis involving the liver and spleen. The mechanism of such portal hypertension is discussed.