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Clinical Journal of Gastroenterology

, Volume 6, Issue 5, pp 368–372 | Cite as

True enteroliths linked to non-specific multiple ulcers of the small intestine: report of a case

  • Hirotsugu Morioka
  • Yuya Ueda
  • Tomohiko Nishihira
  • Tetsuro Ogino
  • Akihiro Miki
  • Shinichiro Yoshitani
  • Yasuhide Ishikawa
  • Mitsushige Shibatoge
  • Tetsuro Hirose
Case Report

Abstract

This report presents a case of true enteroliths linked to non-specific multiple ulcers of the small intestine (CNSU). A 53-year-old male presented with abdominal pain and vomiting, and was admitted to our hospital under a diagnosis of ileus. He had anemia and hypoalbuminemia. Abdominal computed tomography showed that several radio-opaque bodies were present in the dilated small intestine. Double-balloon enteroscopy revealed an eccentric stricture accompanying a linear open ulcer. Well defined oblique and branching ulcers were continuous with the stricture. At laparotomy, we observed 18 stenoses of the small intestine from 190 cm to 110 cm proximal to the ileocecal valve. The stenotic and dilated segments were 1.7 ± 0.4 and 5.4 ± 3.0 (mean ± SD) cm in width, respectively. He underwent a resection of the affected small intestine. The macroscopic observation revealed various types of multiple shallow ulcers that were linear or had a tall, triangular configuration, and their alignment was circular or oblique. The ulcers had fused, thus showing a geographic configuration. The microscopic findings showed the maximum depth of the ulcers to be the submucosal layer. The enteroliths were mainly composed of calcium oxalate. As a result, the patient was diagnosed as having true enteroliths linked to CNSU. True enteroliths are a rare complication of CNSU.

Keywords

Non-specific multiple ulcers of the small intestine True enteroliths Small intestinal ulcer Double-balloon enteroscopy 

Notes

Disclosures

Conflict of Interest: Hirotsugu Morioka, Yuya Ueda, Tomohiko Nishihira, Tetsuro Ogino Akihiro Miki, Shinichiro Yoshitani, Yasuhide Ishikawa, Mitsushige Shibatoge, and Tetsuro Hirose declare that they have no conflict of interest.

Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent: Informed consent was obtained from all patients included in the study.

References

  1. 1.
    Grettve S. A contribution to the knowledge of primary true concrements in the small bowel. Acta Chir Scand. 1947;95(5):387–410.PubMedGoogle Scholar
  2. 2.
    Shut JM, Mallens WMC. Calcified enteroliths in regional enteritis. Diagn Imag Clin Med. 1986;55:146–50.Google Scholar
  3. 3.
    Atwell JD, Pollock AV. Ent-6. Intestinal calculi. Br J Surg. 1960;47:367–74.PubMedCrossRefGoogle Scholar
  4. 4.
    Okabe H, Sakimura M. Nonspecific multiple ulcer of the small intestine (in Japanese with English abstract). Stom Int. 1968;3:1539–49.Google Scholar
  5. 5.
    Hirai F, Matsui T. Chronic hemorrhagic ulcers of the small intestine. Stom Int. 2008;43:603–9.Google Scholar
  6. 6.
    Perlemuter G, Guillevin L, Legman P, Weiss L, Couturier D, Chaussade S. Cryptogenetic multifocal ulcerous stenosing enteritis: an atypical type of vasculitis or a disease mimicking vasculitis. Gut. 2001;48:333–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Matsumoto T, Iida M, Matsui T, Yao T, Watanabe H, Yao T, et al. Non-specific multiple ulcers of the small intestine unrelated to non-steroidal anti-inflammatory drugs. J Clin Pathol. 2004;57:1145–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Chen Y, Ma W-Q, Chen J-M, Cai J-T. Multiple chronic non-specific ulcer of small intestine characterized by anemia and hypoalbuminemia. World J Gastroenterol. 2010;16:782–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Matsumoto T, et al. Chronic nonspecific multiple ulcers of the small intestine: a proposal of the entity from Japanese gastroenterologists to Western enteroscopists. Gastrointest Endosc. 2007;66:599.CrossRefGoogle Scholar
  10. 10.
    Hirai, et al. Chronic hemorrhagic ulcers of the small intestine. Stom Int. 2008;43(4):603–10.Google Scholar
  11. 11.
    Matsumoto, et al. Enteroscopic features of chronic nonspecific multiple ulcers of the small intestine: comparison with nonsteroidal anti-inflammatory drug induced enteropathy. Stom Int. 2006;41(2):1637–48.Google Scholar
  12. 12.
    Matsumoto T, Nakamura S, Esaki M, Yada S, Koga H, Yao T, et al. Endoscopic features of chronic nonspecific multiple ulcers of the small intestine comparison with nonsteroidal anti-inflammatory drug-induced enteropathy. Dig Dis Sci. 2006;51:1357–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Nonaka K, Iwase K, Sando K, Ito T, Mikata S, Mizusima T. A case of true enterolith accompanied by multiple stenosis of the small intestine (in Japanese with English abstract). J Jpn Surg Assoc. 2004;65:2368–73.CrossRefGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Hirotsugu Morioka
    • 1
  • Yuya Ueda
    • 2
  • Tomohiko Nishihira
    • 1
  • Tetsuro Ogino
    • 3
  • Akihiro Miki
    • 1
  • Shinichiro Yoshitani
    • 1
  • Yasuhide Ishikawa
    • 1
  • Mitsushige Shibatoge
    • 2
  • Tetsuro Hirose
    • 1
  1. 1.Department of Gastroenterological SurgeryTakamatsu Red Cross HospitalTakamatsu cityJapan
  2. 2.Division of GastroenterologyTakamatsu Red Cross HospitalTakamatsu cityJapan
  3. 3.Department of PathologyTakamatsu Red Cross HospitalTakamatsu cityJapan

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