MECKEL'S DIVERTICULA-ASSOCIATED ENTEROLITH CAUSING HIGH-GRADE SMALL BOWEL OBSTRUCTION

Objectives: A 67-year-old female presented as a transfer from an outside hospital for a high-grade small bowel obstruction. The patient previously presented with intermittent abdominal pain, nausea, vomiting, and obstipation on 3 separate occasions over the last month, which were all managed conservatively. The patient never fully recovered and had persistent PO intolerance. An independent CT imaging review of the outside hospital's imaging revealed a slightly radiopaque foreign body in the distal ileum at the level of the transition point. An exploratory laparotomy was performed revealing a 3.5 x 3.5 cm Meckel's diverticulum with an associated enterolith that had dislodged causing the high-grade obstruction in the terminal ileum. The patient underwent a small bowel resection with side-to-side anastomosis and recovered well postoperatively. In adults, Meckel's diverticula can present with intestinal obstruction, intussusception, perforated diverticulitis, hemorrhage, or with a tumor. Most cases of Meckel's-associated intestinal obstruction are due to congenital bands or stricturing. Meckel's-associated enteroliths resulting in obstruction are a rare presentation with very few having been reported. Although prior case reports varied slightly in individual presentations, most describe a delayed diagnosis in the setting of intermittent, colicky abdominal pain and concern for obstruction. Meckel's diverticulum-associated enteroliths may be an atypical cause of small bowel obstruction in adults. CT imaging may be useful in establishing a diagnosis; however, a high-level of clinical suspicion is required given that enteroliths may often be missed on radiographic reads.

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