From scar to stone: Enterolith formation in an ileal stricture post-appendectomy – A case report and literature review

TL;DR

A rare case of intestinal stone formation in a man's small intestine, caused by a narrowing from a past appendectomy, was successfully treated with surgery.

Contribution

This case report highlights a rare instance of enterolithiasis caused by a post-appendectomy ileal stricture, emphasizing the importance of considering such etiologies in persistent abdominal symptoms.

Findings

Enterolithiasis can develop decades after an appendectomy due to an ileal stricture.

Radiological imaging is crucial for diagnosing enterolithiasis and distinguishing it from other conditions.

Surgical removal of the affected intestinal segment resolves the condition effectively.

Abstract

The enteroliths are stones of the intestines that may form along the passage of the gastrointestinal tract, especially within the ileum. Their clinical and radiological presentations vary, often leading to misdiagnosis. They may result in delayed complications like intestinal obstruction.

We present a case of enterolithiasis secondary to ileal stricture post-appendectomy, in a 69-year-old male, which was then treated successfully via segmental ileal resection with enterolith extraction and ileoileal anastomosis in our tertiary center after thorough examination.

This case highlights how a seemingly routine post-surgical history can hide a rare condition like enterolithiasis. In our patient, chronic abdominal discomfort after an old appendectomy turned out to be due to a stone formed in the small intestine because of a stricture. It reminds clinicians to consider atypical etiologies when symptoms persist, and to review past surgeries as potential contributors to delayed complications.

Enteroliths are caused by altered bowel state and may seldom cause bowel obstruction. Imaging usually suffices for diagnosis but mimics must be ruled out. Treatment includes endoscopic or surgical removal of enterolith and addressing any causative factors.

•This case underscores the rare occurrence of primary enterolithiasis, secondary to a post-surgical ileal stricture, two decades after an appendectomy.•Radiological clues were critical to raise suspicion for enterolithiasis.•Surgical management ensures complete resolution.•Literature review supports that stasis from strictures- whether inflammatory, neoplastic, or post-surgical-remains a key driver in enterolith formation.

This case underscores the rare occurrence of primary enterolithiasis, secondary to a post-surgical ileal stricture, two decades after an appendectomy.

Radiological clues were critical to raise suspicion for enterolithiasis.

Surgical management ensures complete resolution.

Literature review supports that stasis from strictures- whether inflammatory, neoplastic, or post-surgical-remains a key driver in enterolith formation.

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