A Case of Enterolith Associated with Perforation of Jejunal Diverticula in the Afferent Loop

Kazuhito Inoguchi, Takashi Yoshioka, Shinya Gomi, Hajime Nakai and Yojiro Orita

Department of Surgery, Chugoku Central Hospital of the Mutual
Aid Association of Public School Teachers

We report a case of unique enterolith associated with perforation of jejunal diverticula in the afferent loop. A 75-year-old man, with a history of gastrectomy and oral administration with ursodeoxycholic acid in treating type C chronic hepatitis was admitted to our hospital for abdominal pain on March 12, 2002. The next day, he was referred to surgery for paritonitis and underwent an emergency operation. Gastrointesital reconstruction by Billroth II anastomosis was done at the previous operation. A mesenteric abscess caused by perforation of the jejunum in the afferent loop and an enterolith in the abscess was found at laparotomy. We partially resected the jejunum and reconstructed a gastrojejunostomy by Roux en Y anastomosis. Pathological findings indicated a perforation of jejunal diverticula caused by diverticulitis. The enterolith consisted from a core and to an outer layer. Analysis indicated the core consisted of deoxycholic acid and the outer layer of ursodeoxycholic acid. The enterolith was suggested to be a combination enterolith constructed from a bile acid enterolith as the core and medicine as the outer layer. In the present case, a jejunal diverticula and gastrointestinal reconstruction by Billroth II anastomosis was considered to have caused stagnation of the intestinal contents and bacterial overgrowth, which led to formation of the enterolith.

Key words
enterolith, jejunal diverticula, ursodeoxycholic acid

Reprint requests
Kazuhito Inoguchi Department of Surgery, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers 6-3-1 Nishifukatsu-cho, Fukuyama-shi, 721-8581 JAPAN

Accepted
May 27, 2003

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