Enterolith Ileus as a Complication of Jejunal Diverticulosis
Steenvoorde P. · Schaardenburgh P. · Viersma J.H.
Two Case Reports and a Review of the Literature
Department of Surgery, Spaarne Hospital, Haarlem, The Netherlands
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Article / Publication Details
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.
© 2003 S. Karger AG, Basel
Terry WI, Mugler FR: Diverticula of the jejunum. Arch Surg 1921;2:347–353.
Goodall AL: Intestinal obstruction caused by faecalith. Br Med J 1948;ii:206.
Armitage G, Fowweather FS, Johnstone AS: Observations on bile-acid enteroliths, with an account of a recent case. Br J Surg 1950;38:21–25.
Crassweller H: Multiple diverticula of the jejunum. Can Med Assoc J 1952;67:149–150.
Slater NS: Perforation and obstruction by enterolith complicating jejunal diverticulosis. Br J Surg 1953;41:60–62.
Burkitt R: Intestinal obstruction due to enterolith complicating jejunal diverticulosis. Surgery 1957;41:867–869.
Blair JSG: Jejunal diverticulitis with intestinal obstruction caused by faecolith. Lancet 1959;ii:87–88.
Walker WF, Kerr G, Macdonald JS: Enterolith ileus. Br J Surg 1960;48:143–145.
Atwell JD, Pollock AV: Intestinal calculi. Br J Surg 1960;47:367–374.
- Bewes PC, Haslewood GA, Roxburgh RA: Bile-acid enteroliths and jejunal diverticulosis. Br J Surg 1966;53:709–711.
- Svanes K, Halvorsen JF: Enterolith obstruction of the ileum as a complication of jejunal diverticulitis. Report of a case. Acta Chir Scand 1975;141:816–819.
- Ottinger LW, Carter EL: Obturation of the ileum by a jejunal diverticular enterolith. Gastroenterology 1975;68:1596–1597.
- Cade R, Collopy B, Ryan P: Enterolith ileus complicating a jejunal diverticulum. Aust NZ J Surg 1981;51:309–311.
- Clarke PJ, Kettlewell MG: Small bowel obstruction due to an enterolith originating in a jejunal diverticulum. Postgrad Med J 1985;61:1019–1020.
- Beal SL, Walton CB, Bodai BI: Enterolith ileus resulting from small bowel diverticulosis. Am J Gastroenterol 1987;82:162–164.
- Mortensen PB, Andersen JC: Acute obstruction by enterolith complicating jejunal diverticulosis. Case report. Acta Chir Scand 1987;153:705–706.
- Crane PW, Crocker PR, Levison DA, Gilmore OJ: Enterolith ileus. J R Soc Med 1988;81:292–294.
- Herbetko J, Brunton FJ: Enteroliths of small bowel diverticula. Clin Radiol 1991;43:311–313.
- Lopez PV, Welch JP: Enterolith intestinal obstruction owing to acquired and congenital diverticulosis. Report of two cases and review of the literature. Dis Colon Rectum 1991;34:941–944.
- Pang AS, Aye MM: Jenunal diverticulosis. Case report of a rare cause of mechanical intestinal obstruction. Singapore Med J 1991;32:451–453.
- Mcallion WA, Higgins PM, Dane TEB: Enterolith obstruction of the small bowel. Ulster Med J 1992;61:179–181.
- Goldin J, McLean A, Gerrard DJ, Hocken DB: Case report: Ultrasound in the diagnosis of jejunal enterolith obstruction. Clin Radiol 1995;50:725–726.
- Phelan M, Kaufman H, Becker J, Fitzpatrick G: Small bowel obstruction by jejunal enterolith. Surgery 1997;121:229–230.
- Bowley D, Royle CA: Enterolith ileus as a complication of small bowel diverticulosis. J R Army Med Corps 1997;143:169.
- Klingler PJ, Seelig MH, Floch NR, Branton SA, Metzger PP: Small-intestinal enteroliths – Unusual cause of small-intestinal obstruction: Report of three cases. Dis Colon Rectum 1999;42:676–679.
- Lobo DN, Braithwaite BD, Fairbrother BJ: Enterolith ileus complicating jejunal diverticulosis. J Clin Gastroenterol 1999;29:192–193.
Miller M, Macdonald P, O’Bichere A: Gastrointestinal: Small bowel enterolith ileus. Gastroenterol hepatol 2001;16:697.
Fisher MH: False diverticula of the intestine. J Exp Med 1900;5:333–352.
- Zager JS, Garbus JE, Shaw JP, Cohen MG, Garber SM: Jejunal diverticulosis: A rare entity with multiple presentation, a series of cases. Dig Surg 2000;17:643–645.
Rosedale RS, Lawrence HR: Jejunal diverticulosis. Am J Surg 1936;34:369–373.
Altmeier WA, Bryant LR, Wulsin JH: The surgical significance of jejunodiverticulosis. Arch Surg 1963;60:149–151.
King ESJ: Diverticula of small intestine. Aust NZ J Surg 1950;19:301–319.
- Salomonowitz E, Wittich G, Hajek P, Jantsch H, Czembirek H: Detection of intestinal diverticula by double-contrast small bowel enema: Differentiation from other intestinal diverticula. Gastrointest Radiol 1983;8:271–278.
- Maglinte DD, Chernish SM, DeWeese R, Kelvin FM, Brunelle RL: Acquired jejunoileal diverticular disease: Subject review. Radiology 1986;158:577–580.
Cooke W, Cox E, Fone D: The clinical and metabolic significance of jejunal diverticula. Gut 1963;4:115–131.
- De Bree E, Grammatikakis J, Christodoulakis M, Tsiftsis D: The clinical significance of acquired jejunoileal diverticula. Am J Gastroenterol 1998;93:2523–2528.
- Wilcox RD, Shatney CH: Massive rectal bleeding from jejunal diverticula. Surg Gynecol Obstet 1987;165:425–428.
- Von Putzki H, Student A: Zur Divertikulose des Jejunums and Ileums. Zentralbl Chir 1987;112:696–702.
- Kuzaat M, Carneiro PM, Spitz L: Jejunal diverticulum in a child presenting with small bowel obstruction. J R Coll Surg Edinb 1992;37:195.
- Berry DF, Willing SJ, Beers GJ: Small bowel obstruction due to enterolith: CT appearance. J Comput Assist Tomogr 1987;11:707–708.
- Leow CK, Lau WY: Treatment of small bowel obstruction by jejunal enterolith. Surgery 1997;122:977–978.
Article / Publication Details
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