A Case of Partial Small Bowel Obstruction in Crohnʼs Disease Patients Due to Enterolith

Abstract

Purpose: Enteroliths are associated with conditions that increase stasis in the bowel. Less than 100 cases of enteroliths have been reported in the literature from all causes. Enteroliths are very rarely associated with Crohn's disease (CD). We report a case of an Enterolith causing intermittent small bowel obstruction (SBO) in a Crohn's Disease patient. A 31 year-old male with long standing CD presented with complaints of RLQ abdominal pain, distension with non-bloody diarrhea. He reported a gradual but progressive worsening of his symptoms over a two week period prior to presentation. His CD course was significant for an ileocecal resection at age 18 for SBO and abscess formation. His meslamine dose was recently increased due to worsening symptoms but without any clinical improvement. He experienced increased frequency of abdominal pain and distension leading to admission with a SBO three months prior. He was hesitant to start immunomodulators despite being advised. In the ER, patient was afebrile with stable vitals. His abdomen was distended with tenderness in the periumbilical and right lower quadrant without any guarding or rigidity. His WBC count and chemistries were normal. A CT enterography showed a narrowed portion of the distal ileum, proximal dilatation and calcification which was thought to be an enterolith. Given the patient's intermittent obstructive symptoms and CT scan findings, proximal ileal resection with enterolith removal was performed. Pathology report of the surgical specimen revealed an enterolith and a severe stricture, with ulceration and active inflammation with hemorrhage. The patient symptoms resolved following surgical resection. Enteroliths are more commonly seen in conditions such as Meckel's diverticulum, jejunal diverticulum, radiation enteritis, blind pouches from gastrointestinal anastomosis and adenocarcinoma. To our knowledge, only 25 cases of enteroliths in CD patients have been reported. Enteroliths are usually asymptomatic and may incidentally be found on imaging. Rarely enteroliths can cause intermittent obstructive symptoms. Enteroliths in CD patients have been associated with refractory chronic anemia. Several cases have been reported in which adenocarcinoma was found in strictured bowel with enteroliths. It appears that definitive treatment for enteroliths in CD patients is segmental resection and enterolith removal.Figure