Jejunal diverticulitis with migration of a large, obstructing enterolith

Case contributed by Dr Michael P Hartung

Presentation

Abdominal pain.

Large inflamed jejunal diverticulum containing an oval enterolith centrally. 

Patient has now developed nausea and vomiting. 

Jejunal diverticulitis has improved, with smaller and less inflamed diverticulum. However, the enterolith has now migrated into the distal small bowel and resulted in small bowel obstruction. 

Jejunal diverticulitis continues to improve. 

Small bowel obstruction has slightly improved with NG tube placement. 

The enterolith has advanced slightly but remains lodged in the small bowel, resulting in obstruction.

3 cm round enterolith surgically removed.

Annotated images review key findings from each day. 

Case Discussion

Fascinating cases with jejunal diverticulitis followed by migration of the enterolith into the small bowel following treatment with antibiotics, causing a "gallstone ileus"-type small bowel obstruction, ultimately requiring surgical management.  

Notice how difficult it is to see the enterolith and appreciate it as the cause of obstruction! 

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