Question:
A 60 year lady presented with features of large bowel obstruction to the emergency room. She was admitted twice before with features of subacute bowel obstruction at another center but was managed conservatively. Her blood reports showed leucocytosis while the rest was normal. Her abdominal X-ray showed few dilated ileal loops with multiple air fluid levels. Unusual finding on X-ray was the presence of enteroliths on the right lumbar and hypochondriac region. What do you suggest should be the management?
  1. Conservative management
  2. Laparotomy and extraction of the enteroliths alone
  3. Colonoscopy
  4. Exploratory laparotomy with bowel resection without cholecystectomy
  5. Exploratory laparotomy with bowel resection with cholecystectomy
Here in our case we had to do an exploratory laparotomy with right hemicolectomy and cholecystectomy. As it was a case of gall stone ileus with stricture in the ascending colon suspicious of underlying pathology. (Figure 1)
Enteroliths are classified as primary enteroliths -which are formed within the gastrointestinal tract or secondary enteroliths, stones which form outside the bowel and migrate to the intestine,1of which the most common type is gallstones. Optimal treatment of enterolithiasis should focus on enterolith removal and correction of underlying pathology to prevent future formation of additional enteroliths.2