FOCAL SMALL BOWEL STRICTURE WITH SAIO & ENTEROLITHS

[ An ultrasound diagnosis with X-ray work up ]


Case & Imaging Details In Brief

By-DR. SUBHASH TAILOR, MD
Bhilwara, Rajasthan [ INDIA]

A 45yrs old female with H/O recurrent abdominal pain & vomiting , subjected to sonography abdomen, revealed an area of focal short segmental small bowel mural thickening with luminal narrowing[stricture] in suprapubic area,likely involving ileal segment. The proximal bowel loop & few other loops were also seen dilated . Interestingly two well defined echodense shadows were also detected , one being entrapped at the site of stricture [fig 1] , & another one slightly proximal to the former , present in distended bowel loop [ fig 2 ].These are suggested to be enteroliths , likely formed due to concentric calcific condensation over fecolith facing chronic stasis [see fig 3 ] . At the same time radiograph abdomen was performed which showed two adjacent classical oval shaped enterolith opacities [see fig 3 ]. This diagnosis can be suggested in appropriate clinical & imaging situation. More views are welcome !

Fig 1 – Suprapubic US scan shows focal small bowel stricture with entrapped enterolith,both in TS & LS views.

Fig 2 – US scan shows separate another well defined enterolith with distal shadowing in proximal dilated small bowel loop

Fig 3 - US scan shows both enteroliths , one in the region of stricture , & another lodged adjacently in distended proximal small bowel loop

Fig 4 X –ray abdomen shows two adjacently lodged classical oval shaped enterolith opacities in lower abdomen