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?
- Conservative management
- Laparotomy and extraction of the enteroliths alone
- Colonoscopy
- Exploratory laparotomy with bowel resection without cholecystectomy
- 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