PMC5610872_01
Endoscopic and radiologic images. Colonoscopy performed 15 months previously shows ulceration and stenosis (a) and a mass trapped in the semi-closed lumen in the cecum ((b), arrow). Another ulceration is observed in the anastomotic site (c). CT shows a calcified mass in the cecum ((d), arrow) and fecalomas within the appendix ((e), arrow).
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A colonoscopy performed 15 months prior to her admission revealed ulceration and stenosis of the cecum (Figure 1(a)). A mass that appeared to be feces was observed in the semi-closed lumen in the cecum (Figure 1(b)). Ulceration was also observed in the anastomotic site (Figure 1(c)). On admission, computed tomography scanning demonstrated a calcified mass that was impacted in the cecum (Figure 1(d)) and fecalomas within the appendix (Figure 1(e)).
Photographs of the enterolith. Enterolith of 3 x 2 cm in size was surgically removed (a). The cut surface shows a multilayered structure (b).
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 Figure 2 shows the surgically removed enterolith of 3 x 2 cm in size (Figure 2(a)). Multiple-layered structures were seen in the cut surface, resembling annual rings of a tree (Figure 2(b)).
Photographs of the enterolith pieces. A piece before immersing in double distilled water (a) and a piece before immersing in 2% citric acid solution (b). After 120 hours of immersion and 30 minutes of air-drying, the color of the enterolith piece immersed in citric acid solution turned to black and appeared to have shrunken (d), compared with the piece immersed in water (c).
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Osaka, Japan) in double-distilled water. One piece (Figure 3(a)) was completely immersed in double-distilled water, and the other (Figure 3(b)) was immersed in a 2% citric acid solution. The color of the enterolith piece immersed in citric acid solution turned black in color and appeared to have shrunken (Figure 3(d)), compared with the piece immersed in water (Figure 3(c)).
Scanning electron microscopy images. The enterolith piece immersed in water revealed a multilayered structure (a), containing crystalloid microparticles (b). In the enterolith piece immersed in citric acid solution, crystalloid microparticles were absent (c, d).
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S4800 scanning electron microscopy and EDAX Genesis APEX2 energy-dispersive X-ray spectroscopy. Scanning electron microscopy analysis of the enterolith piece immersed in water revealed a multilayered structure (Figure 4(a)), which was partly composed of crystalloid microparticles (Figure 4(b)). In the enterolith piece immersed in citric acid solution, crystalloid microparticles were absent (Figures 4(c) and 4(d)).
Elemental mapping images. The enterolith piece immersed in water contained calcium (a), magnesium (b), and phosphate (c). A photograph merged with a scanning electron microscopy image (d) and mapping images of calcium and magnesium showed that the enterolith piece was composed of two kinds of layers (e).
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Elemental mapping revealed that the enterolith piece immersed in water contained calcium (Figure 5(a)), magnesium (Figure 5(b)), and phosphate (Figure 5(c)). A photograph merged with scanning electron microscopy image (Figure 5(d)) and mapping images of calcium and magnesium clearly showed that the enterolith piece was composed of two kinds of layers (Figure 5(e)).
Spectra obtained using energy-dispersive X-ray spectroscopy. Calcium, magnesium, and phosphate exist in the enterolith piece immersed in double-distilled water (a). The amount of these elements was decreased in the piece immersed in the citric acid solution (b).
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Spectra obtained with energy-dispersive X-ray spectroscopy showed that calcium, magnesium, and phosphate existed in the enterolith piece immersed in water (Figure 6(a)), whereas the amount of these elements was decreased in the piece immersed in citric acid solution (Figure 6(b)).