A Case of Afferent Loop Obstruction caused by an Enterolith

Susumu Yamamura, Tadashi Kobayashi, Masaaki Kobayashi, Itsuo Fujita*, Shigeki Yokomuro*, Yoshiharu Nakamura*, Takayuki Aimoto*, Eiji Uchida* and Takashi Tajiri*

Department of Surgery, Kobayashi Hospital
Surgery for Organ Function and Biological Regulation,
Nippon Medical School, Graduate School of Medicine*

A 75-year-old woman was admitted to our hospital because of abdominal pain and vomiting. Computed tomography (CT) detected a high-density mass 3 cm in diameter around the navel. The mass was obstructing the proximal jejunum, and the patient had ileus. The patient had a history of distal gastrectomy (B-II) 35 years ago because of gastric ulcer and cholecystectomy 6 years ago because of cholecystlithiasis. After admission, an ileus tube relieved the ileus, but a month later the ileus recurred. CT showed that the mass had moved to another position in the jejunum. Surgery was performed for a preoperative diagnosis of the fecolith or foreign body of the small intestine. Intraoperative exploration revealed afferent loop obstruction caused by an enterolith. The enterolith was removed, and Braun's anastomosis was performed. The enterolith was composed of two sections, and the proximal side had an annual-ring-like structure. The outer section contained cholesterol, bilirubin calcium and fatty acid calcium. The center section contained bilirubin calcium, fatty acid calcium, and unknown substances. A small gallstone had passed through the common bile duct and formed an enterolith in the afferent loop. Afferent loop obstruction caused by an enterolith after gastrectomy is very rare, and only 5 cases have been reported in the Japanese literature.

Key words
enterolith, afferent loop obstruction, ileus

Reprint requests
Susumu Yamamura Department of Surgery, Kobayashi Hospital
3-10-8 Narimasu, Itabashi-ku, 175-0094 JAPAN

Accepted
May 31, 2006

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