Introduction

True primary enteroliths are a rare condition when stones or concretions are formed within the lumen of the bowel. The most common presentation of enteroliths is acute intestinal obstruction. In contrast, we report a rare case of true primary enteroliths that presented with burning micturition, multiple episodes of loose stool, vomiting, and pain in the lower abdomen. Moreover, the X-ray of the abdomen mimicked vesical calculus, making the diagnosis confusing.

Case Presentation

A 52-year-old female presented to surgery emergency with complaints of acute pain in the lower abdomen, vomiting, and multiple episodes of loose stools for the past 15 days. The patient also developed burning micturition and difficulty in passing urine for the last 2 days. On examination, the patient was dehydrated with a pulse rate of 110 beats per minute, blood pressure was 110/66 mmHg, the abdomen was soft with tenderness in the lower abdomen, and bowel sounds were normal. A plain X-ray abdomen showed radio-opaque shadows in the lower abdomen that mimicked urinary bladder stones. However, stones in the urinary bladder were not found in the USG abdomen and the NCCT abdomen. Surgery was performed after 6 days of failed conservative management. Multiple hard stones were found impacted within a 30 cm thickened and inflamed segment of the distal ileum. Chemical analysis of the stones revealed calcium oxalate, calcium carbonate, and uric acid as their constituents.

Conclusion

Enterolith may present with atypical clinical symptoms and signs. However, with a diligent approach and proper investigation, diagnosis can be determined.