Primary Enterolith-Induced Small Bowel Obstruction in an Elderly Male Without Underlying Intestinal Pathology: A Case Report.

Enteroliths are a rare cause of intestinal obstruction. When obstruction is caused by an enterolith, it is often associated with underlying intestinal anomalies, such as diverticula. Acute intestinal obstruction in a structurally normal intestine is extremely uncommon. Although enterolith-induced obstruction has been reported in the literature, most cases involve some form of intestinal abnormality. Enteroliths form when calculi develop within the intestinal lumen, and their size can vary. They are classified as primary or secondary, depending on their origin. Primary enteroliths usually occur in younger individuals; however, in this case, the enterolith developed in a 75-year-old patient, highlighting the rarity of the presentation. Patients typically present with non-specific gastrointestinal symptoms, including nausea, vomiting, and abdominal distension. Plain abdominal radiographs are often the first-line diagnostic tool but detect only radiopaque enteroliths, which represent about one-third of cases. Computed tomography (CT) scans and oral contrast studies provide better diagnostic accuracy for both radiopaque and radiolucent stones. Surgical management remains the treatment of choice. In the reported case, a 75-year-old male presented with a two-day history of crampy abdominal pain, bilious vomiting, progressive abdominal distension, and failure to pass feces or flatus. Laboratory and imaging studies, including a plain abdominal radiograph, confirmed intestinal obstruction. After discussion with the patient and family, laparotomy was performed. An enterolith was identified and removed via enterotomy, with no underlying intestinal anomalies. The patient’s symptoms resolved completely. He was closely monitored postoperatively for five days and discharged with follow-up instructions. During subsequent outpatient visits, he remained symptom-free and received routine postoperative advice. • Small bowel obstruction is a common surgical emergency, with postoperative adhesions being the leading cause. • Enteroliths are rare intestinal concretions that can cause obstruction, typically forming in areas of bowel stasis. • Primary enteroliths usually occur in younger adults, making cases in elderly patients without intestinal anomalies extremely rare. • Diagnosis can be challenging, as only one-third of enteroliths are visible on plain radiographs, making CT scans crucial for detection. • Surgical intervention remains the mainstay of treatment for large or impacted enteroliths, ensuring symptom resolution and preventing complications.