Enterolith Ileus as a Complication of Jejunal Diverticulosis
Two Case Reports and a Review of the LiteratureSteenvoorde P. · Schaardenburgh P. · Viersma J.H.
Department of Surgery, Spaarne Hospital, Haarlem, The Netherlands
Background: In a period of 5 years, 2 patients with enterolith ileus, caused by jejunal diverticulosis, were treated in our hospital. In order to learn more about treatment options, the literature was reviewed. Methods: The case history of the 2 patients is described. Relevant articles were identified using Medline® and PubMed®. Data regarding patient gender, age, operative findings, therapeutic measures and outcome were collected. Results: Including patients reported in the literature, 34 cases of intestinal obstruction due to enteroliths expelled from jejunal diverticula were identified. A distinction is made between complicated and uncomplicated enterolith ileus. If there are signs of bowel ischemia, other (unborn) enteroliths, inflammation of the bowel or if there are signs of a (sealed) perforation, the case is considered a complicated enterolith ileus. If none of these signs are present, uncomplicated enterolith ileus is present. In uncomplicated enterolith ileus (21 patients), more often milking and crushing or enterotomy was performed. In complicated enterolith ileus (13 patients), more often a segmental resection of the involved jejunum was performed (p < 0.01). Conclusion: Small bowel obstruction due to enteroliths expelled from jejunal diverticula is a rare condition. Relevant literature is only available in the form of case reports. On the basis of the presented patients and patients reported in the literature, a justifiable therapeutic strategy is presented. The least invasive step in the therapeutic approach is to crush and milk the obstructing enterolith down to the colon. Laparoscopic crushing and milking of the enterolith is described. If this fails an enterotomy could be tried, if possible proximal or distal from the obstruction site, in order to make an incision in a less edematous area. If the first two strategies fail, or if complicated enterolith ileus is present, resection of the involved jejunal segment could be considered.