Location
Philadelphia, PA
Start Date
17-4-2026 1:30 PM
End Date
17-4-2026 2:30 PM
Description
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. It is usually asymptomatic and often discovered incidentally. Complications include gastrointestinal bleeding, diverticulitis, and most commonly, obstruction. We report a rare case of small bowel obstruction (SBO) caused by an enterolith originating from an inflamed MD.
A 77-year-old male presenting with approximately 3 days of diffuse abdominal cramping with associated emesis and new onset diarrhea. CT imaging showed a dilated small bowel with a transition point in the right pelvis with a large calcified mass (4.2x2.9cm) in the associated small bowel, suspected to be the distal ileum. The patient was admitted for SBO with NGT placement, and planned to go to the OR for an exploratory laparotomy due to obstruction secondary to a possible bezoar. Obstruction series on the day of procedure showed contrast still within the stomach with dilated loops of small bowel; additionally, the patient was noted to have an increasing leukocytosis of 11.9 from 10.8 on admission. Intraoperatively, a large, obstructing fecalized foreign body was found adjacent to the terminal ileum, and proximally a large inflamed MD. A small bowel resection was performed, taking the diverticulum and bowel containing the foreign body. Pathology showed a MD with chronic inflammation, and a 4.6 cm foreign body consistent with an enterolith. The patient progressed well postoperatively despite a postoperative ileus. On postoperative day 7, the patient was surgically stable for discharge, having had a return of bowel function and tolerating diet.
Complications from a MD most frequently present before the age of 2. MD can present later in adulthood, though less frequently, as ~84% of cases are asymptomatic and discovered incidentally. This case illustrates a rare complication resulting from a MD, specifically the formation of an enterolith and subsequent SBO. The formation of enteroliths is suggested to be due to the stasis of enteric contents, often caused by strictures from IBD, chronic infections, or, in this case, due to a MD. It has been estimated that approximately 3-10% of patients with MD have enteroliths. Of the limited reports on enterolith-related complications, the median patient age was 45 years old, with 75% of cases reporting intermittent abdominal pain4. When enteroliths cause an SBO, prompt surgical intervention is essential, as nonoperative management is ineffective and may lead to life-threatening complications such as tissue ischemia or perforation.
Embargo Period
6-4-2026
Included in
A Hard Case to Pass: Small Bowel Obstruction from an Enterolith in Meckel’s Diverticulum
Philadelphia, PA
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. It is usually asymptomatic and often discovered incidentally. Complications include gastrointestinal bleeding, diverticulitis, and most commonly, obstruction. We report a rare case of small bowel obstruction (SBO) caused by an enterolith originating from an inflamed MD.
A 77-year-old male presenting with approximately 3 days of diffuse abdominal cramping with associated emesis and new onset diarrhea. CT imaging showed a dilated small bowel with a transition point in the right pelvis with a large calcified mass (4.2x2.9cm) in the associated small bowel, suspected to be the distal ileum. The patient was admitted for SBO with NGT placement, and planned to go to the OR for an exploratory laparotomy due to obstruction secondary to a possible bezoar. Obstruction series on the day of procedure showed contrast still within the stomach with dilated loops of small bowel; additionally, the patient was noted to have an increasing leukocytosis of 11.9 from 10.8 on admission. Intraoperatively, a large, obstructing fecalized foreign body was found adjacent to the terminal ileum, and proximally a large inflamed MD. A small bowel resection was performed, taking the diverticulum and bowel containing the foreign body. Pathology showed a MD with chronic inflammation, and a 4.6 cm foreign body consistent with an enterolith. The patient progressed well postoperatively despite a postoperative ileus. On postoperative day 7, the patient was surgically stable for discharge, having had a return of bowel function and tolerating diet.
Complications from a MD most frequently present before the age of 2. MD can present later in adulthood, though less frequently, as ~84% of cases are asymptomatic and discovered incidentally. This case illustrates a rare complication resulting from a MD, specifically the formation of an enterolith and subsequent SBO. The formation of enteroliths is suggested to be due to the stasis of enteric contents, often caused by strictures from IBD, chronic infections, or, in this case, due to a MD. It has been estimated that approximately 3-10% of patients with MD have enteroliths. Of the limited reports on enterolith-related complications, the median patient age was 45 years old, with 75% of cases reporting intermittent abdominal pain4. When enteroliths cause an SBO, prompt surgical intervention is essential, as nonoperative management is ineffective and may lead to life-threatening complications such as tissue ischemia or perforation.
Comments
Presented by Michaela Abraham.