Enterolithiasis: An unusual cause of large bowel obstruction, a case report

BACKGROUND: Large bowel obstruction is a common surgical condition encountered in the surgical emergency department. Large bowel obstruction due to primary enterolithiasis is an extremely uncommon condition. Enterolithiasis i.e. formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis due to various pathologies and can present in different clinical pictures to challenge a clinician. CLINICAL PRESENTATION: a 60-year-old male farmer who had sigmoid resection and anastomosis six years back, currently presented with a complaint of recurrent abdominal cramps, progressive abdominal distension, vomiting, and constipation of 08 days duration. An examination showed a distended soft and non-tender abdomen. A plain abdominal x-ray showed an obstruction caused by enteroliths located at the proximal rectum. The patient was diagnosed with large bowel obstruction due to an impacted enterolith at the stenosed previous anastomotic site. Later, the patient was operated on, impacted enteroliths were removed, and was discharged improved. CONCLUSION: definitive preoperative diagnosis of bowel obstruction due to enterolithiasis is not always possible. A high index of suspicion is very important to avoid misdiagnosis and delay in treatment. Most patients with enterolithiasis can be managed conservatively. However, surgery is the mainstay of treatment once conservative management fails.