PMC6077837_01
Computed tomography (CT) image.. (a) Contrast-enhanced CT scan showing a large calcified ring in the duodenal afferent loop (yellow arrow).. (b) Contrast-enhanced CT scan showing a dilated common bile duct and intrahepatic bile duct.. (c) CT scan on 7 days after admission showing an enterolith move into the distal ileum (yellow arrow).
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C-reactive protein, 22.09 mg/dL (normal range, 0-0.5 mg/dL); white blood cell count, 9260/muL (normal range: 4500-9000 /muL); total bilirubin, 5.6 mg/dL (normal range 0.2-1.0 mg/dL); aspartate aminotransferase, 189 IU/L (normal range 8-38 IU/L); alanine aminotransferase, 280 IU/L (normal range 4-44 IU/L); alkaline phosphatase, 1635 IU/L (normal range 104-338 IU/L); gamma-glutamyl transpeptidase, 376 IU/L (normal range 16-73 IU/L); and tumor marker levels were within the normal ranges (carcinoembryonic antigen, 1.0 ng/mL; carbohydrate antigen 19-9, 3 U/mL). Contrast-enhanced computed tomography (CT) at admission showed an enterolith (24 mm in size) in the duodenal afferent loop and a dilated common bile duct and intrahepatic bile duct (Fig. 1a, b). The CT on day 7 revealed that the enterolith moved into the distal ileum (Fig. 1c), and an abdominal radiograph showed multiple niveau formation (Fig. 2a).
Abdominal radiograph and shema.. (a) Abdominal radiograph on 7 days after admission showing multiple niveau formation.. (b) The schema of the abdominal findings. 1. The enterolith located at 40 cm proximal from the ileocaecal junction, leading the obstruction of ileum. 2. The intestinal malrotation of the non-rotation type was revealed: the Treitz ligament was not formed and the second portion of the duodenum was poorly fixed in the retroperitoneum. Moreover, the small intestine was located in the right side and the colon was located in the left side of the abdominal cavity.
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Moreover, the small intestine (jejunum and ileum) was located on the right side and the colon was located in the left side of the abdominal cavity (Fig. 2b).
Intraoperative findings.. (a) The enterolith located in the distal ileum leading the obstruction and dilation of the oral side of the ileum (black arrow).. (b) Enterotomy with removal of the enterolith was performed.. (c) Histological analysis showing a stone composed of necrotic vegetable tissue with calcification.
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The bowel loops proximal to the enterolith were dilated; thus, enterotomy with removal of the enterolith was performed (Fig. 3a, b). Histological analysis revealed a calcified stone composed of necrotic vegetable tissue (Fig. 3c).