OVERVIEW
Enteroliths are bile acid stones produced by precipitates such as barium and calcium salts that are insoluble in water and digestive fluids, swallowed material, or material normally present in the intestine. The obstruction caused by this stone blocking the narrowing of the intestinal lumen is called enterolithic intestinal obstruction.
Causes
Primary intestinal bile acid stones may be caused by overproduction of gastric acid, which lowers the pH of the proximal jejunum, or by bacterial overgrowth in the intestinal collaterals, which decreases the jejunal pH and breaks down the bile salts to form bile acids, which are insoluble in water and form crystals of bile acids in the jejunum where the pH is low. Bile acid crystals can be used as the core of the stone, and some inorganic salts that cannot be dissolved or digested, food or foreign objects, etc. in the gastrointestinal tract to form a special coagulum or hard lumps, which will become intestinal stones, and the increase of the stone to block the small intestine will lead to intestinal stone intestinal obstruction.
Symptoms
The clinical manifestations of enterolithic intestinal obstruction are similar to those of gallstone intestinal obstruction. At the beginning, it is often a partial obstruction, when the intestinal stone moves down with peristalsis to the end of the ileum, where the intestinal lumen is smaller, complete intestinal obstruction can occur. Therefore, the site of obstruction is mostly seen in the end of the ileum, and in a few cases, it can be seen in the duodenum, colon, rectum and other parts. Gastrointestinal bleeding can occur when the intestinal stone is abraded or compressed by necrosis of the intestinal mucosa, and can also cause intestinal torsion, intestinal wall necrosis, perforation and the formation of diffuse peritonitis. Sometimes brownish red fruit skin or hair can be seen in vomit or feces.
Examination
1. X-ray plain film of the abdomen
It shows signs of partial or complete intestinal obstruction. Barium meal or barium enema shows dilatation of intestinal collaterals and filling defects in the intestinal lumen.
2. Gastroduodenoscopy
Gastroduodenoscopy is more helpful for gastrolith and duodenal obstruction.
3. Ultrasound
Strong celiac reflux and curved uneven strong echogenic bands can be seen in the intestinal lumen, and the echogenic bands are followed by sequentially attenuated acoustic shadows.
Diagnosis
Based on the history, combined with X-ray, endoscopy and ultrasound, the diagnosis is usually not difficult. However, those with atypical presentation can only be diagnosed by surgery.
Complications
Intestinal torsion, intestinal wall necrosis and perforation are common complications of the disease.
Treatment
A small number of patients can be relieved by non-surgical treatments such as fasting, gastrointestinal decompression, antispasmodic and analgesic treatments, and oral liquid paraffin. Most patients still require surgical treatment.