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Largest sized enterolith ileus due to a duodenal diverticulum in a virgin abdomen causing small bowel obstruction
  1. Sarah Jane Afify1,
  2. Jayan George2,3,
  3. Clive Johnston Kelty3 and
  4. Nehal Shah3
  1. 1Intensive Care Medicine, Chelsea and Westminster Hospital, London, UK
  2. 2Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, The University of Sheffield, Sheffield, UK
  3. 3General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
  1. Correspondence to Jayan George;{at}


We describe the case of a 73-year-old woman with a high body mass index and a virgin abdomen who presented with a 5-day history of abdominal pain, emesis and confusion on admission. Inflammatory markers and renal function were significantly deranged. CT of the abdomen and pelvis demonstrated a clear transition point and faecalisation of the small bowel proximal to the obstruction. It was suggested that the patient may have ingested a foreign object. A collateral history was obtained, making this less likely and confirmed an acute cognitive impairment. She was optimised following multidisciplinary discussion preoperatively. Thereafter, the patient underwent a laparotomy, where a hard, mobile mass was identified in the jejunum. This was diagnosed as an enterolith of dimensions 62×38×32 mm secondary to a duodenal diverticulum. She improved postoperatively with complete resolution of her confusion and renal function. She was discharged on day 14 of admission.

  • gastrointestinal surgery
  • general surgery

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  • Correction notice This article has been corrected since published online. Figures 1 & 2 are swapped and updated to match the captions and in-text citations.

  • Contributors SJA: writing, drafting and proofing. JG: writing, drafting and editing. CJK: editing and article conception. NH: editing and article conception.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.