Conservative and surgical management of small bowel diverticulitis complicated by enteroliths: A case report.

INTRODUCTION

Small bowel diverticulitis with enterolith-associated small bowel obstruction is a rare complication which can lead to significant morbidity and mortality. Here we present a case of small bowel diverticulitis which underwent successful conservative management at the time of initial presentation but required a surgical intervention for enterolith-associated small bowel obstruction during a subsequent hospitalization.

CASE PRESENTATION: We report the case of a 73-year-old female who presented with a small bowel diverticulitis and incidental discovery of an associated enterolith on contrast-enhanced computed tomography (CT). Patient responded well to nonoperative management with antibiotic therapy during the initial hospitalization. However, patient had short interval readmission due to small bowel obstruction secondary to the previously identified enterolith. Emergent surgical intervention was performed with extraction of an enterolith measuring 3 × 3 × 1.5 cm. The postoperative course was uneventful with immediate return of bowel function.

DISCUSSION: Small bowel diverticulitis with enterolith-associated small bowel obstruction has been reported as a rare complication of small bowel diverticulosis. Obstructive symptoms caused by enteroliths >2.5 cm is less likely to self-resolve with nonoperative management. Prompt surgical intervention with enterolith extraction via simple enterotomy is a safe and effective approach to prevent further complications and avoidable hospital stay.

CONCLUSION

In patients presenting with enterolith-associated small bowel obstruction, prompt evaluation and diagnosis with contrast-enhanced CT is recommended. Large enteroliths causing obstructive symptoms should be addressed with surgical intervention.