TY - JOUR T1 - Largest sized enterolith ileus due to a duodenal diverticulum in a virgin abdomen causing small bowel obstruction JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2021-245159 VL - 14 IS - 11 SP - e245159 AU - Sarah Jane Afify AU - Jayan George AU - Clive Johnston Kelty AU - Nehal Shah Y1 - 2021/11/01 UR - http://casereports.bmj.com/content/14/11/e245159.abstract N2 - 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. ER -