Ahmad, I

Naeem, S A

Rizvi, I H

Sheikh, M Y

English

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eCommons@AKUDepartment of Radiology Medical College, PakistanNovember 1991Enterolithiasis secondary to intestinal tuberculosisM Y. SheikhAga Khan UniversityI H. RizviS A. NaeemI AhmadFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiolPart of the Radiology CommonsRecommended CitationSheikh, M. Y., Rizvi, I. H., Naeem, S. A., Ahmad, I. (1991). Enterolithiasis secondary to intestinal tuberculosis. Journal of PakistanMedical Association, 41(11), 286-287.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/186ENTEROLITHIASIS SECONDARY TO INTESTINALTUBERCULOSISPages with reference to book, From 286 To 287 Mohammad Younus Sheikh, Shabbir Ahmad Naeem, Iftikhar Ahmad  ( Department of Radiology, The Aga Khan UniversityMedical Centre, Karachi. ) Imtiaz Hussain Rizvi  ( Departments of Radiology, The Aga Khan University Medical Centre, Karachi. ) Intestinal tuberculosis is a relatively common ailment in South East Asia. Enterolithiasis is a rarecomplication due to stasis caused by stricture formation. We present a case of enterolithiasis secondaryto intestinal tuberculosis.CASE REPORT A 59 year old lady presented in emergency room with signs and symptoms of sub acute intestinalobstruction. She gave history of recurrent abdominal pain. hematological investigations were withinnormal limits. Serum calcium was 9.6 mg% and phosphate was 4.4 mg%. Chest X-ray revealed oldhealed tuberculosis. Abdominal films showed multiple, faceted calculi in lower abdomen (Figure 1).These calculi were proved to be in dilated terminal ileum on barium enema, seen as filling defects.Calculi were impacted proximal to distalileal stricture (Figure 2).Onlaparatomy ileum was found to be scarred. Limited right hemicolectomy with end to end ileocolos-tomy was performed. Histopathology showed chronic granulomatous changes in ileum. Chemicalanalysis of the stones was not performed.DISCUSSION Enterolithiasis is a rare disease complicating stasis in small or large bowel. It has been described withcongenital and acquired diverticula1,2. Stone formation is also associated with Crohn’s disease,intestinal tuberculosis and malignancy leading to stricture formation1-4. Stones usually form aroundnidus of vegetable origin or bacterial clumps5. Enteroliths are divided into two groups, false enterolithswhich are inspissated intestinal contents (fecoliths) and true enteroliths6. True enteroliths are againclassified into those that are formed in proximal small bowel and distal small bowel. Stones that areformed in proximal small bowel are composed of choleic acid and are radiolucent. These are thecommonest type of enteroliths found. These may be formed in duodenal or jejunal diverticula due toaltered flora because of stasis. Second type of true enteroliths are formed in distal small bowel and areradio-opaque, composed of calcium carbonate or calcium phosphate in nature. This is because of thefact that distal small bowel is more alkaline which renders calcium less soluble. Stones composed ofcalcium oxalate1. Magnesium barium and casein4 have also been reported. Patients present withsymptoms of intermittent acute or subacute intestinal obstruction. Diagnosis depends on seeing mobilecalcific densities on repeated plain abdominal films3. Barium enema and enteroclysis can be used toconfirm the stones to be in the intestinal lumen. C.T. appearance of enterolith has been described5which presents as concentric laminated mass resembling intersusseption. Enteroliths should be dif-ferentiated from vesical calculi, gall stones, and renal calculi. Oral cholecystogram, excretoryurography and ultrasound are helpful in differentiating.ADDENDUM Four more cases of enterolithiasis were diagnosed. These patients presented with symptoms of subacuteintestinal obstruction. Enterocolysis was performed on these patients which confirmed stones in thelumen of small bowel, proximal to ileal stricture. Two of these patients had evidence of pulmonarytuberculosis. They were all treated with antituberculous chemotherapy.REFERENCES 1. Rathore, A.H. and Khan, Ml. Enterolith. JPMA., 1981; 31:49.2. Atwell, J.D. and Pollock, A.V. Intestinal calculi. Br. J. Surg., 1960; 47:367.3. Chawla, S., Beery, K and Indra, K.J. Enterolithiasis complicating intestinal tuberculosis. Clin.Radiol., 1966; 17:274.4. Singleton, 3M. Calcific enterolith obstruction of the intestine. Br. 3. Surg., 1970;57:234.5. Berry, D.F., Willing, SJ. and Beers, G.J. Small bowel obstruction due to enterolith: CT appearance. J.Comput. Assist. Tomogr., 1987;11:707.6. Gardiner, K.R. and Maxwell, R.J. Incidental enterolithiasis. Ulster Med. J., 1989;58:196.

Enterolithiasis secondary to intestinal tuberculosis

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Enterolithiasis secondary to intestinal tuberculosis

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