Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Medicina (Kaunas). 2023 Mar 15;59(3):573. doi: 10.3390/medicina59030573.
A 71-year-old woman with rheumatoid arthritis who had been taking NSAIDs for many years consulted our hospital for abdominal pain. She was diagnosed with a small bowel obstruction due to an enterolith according to an abdominal CT scan that showed dilation from the enterolith in the small intestine on the oral side. It was considered that the intestinal stone was formed due to stagnation of intestinal contents and had gradually increased in size, resulting in an intestinal obstruction. We performed antegrade double-balloon endoscopy (DBE) to observe and remove the enterolith. We used forceps and a snare to fracture the enterolith. During this attempt, we found a seed in the center of the enterolith. Since the intestinal stone was very hard, cola dissolution therapy was administered from an ileus tube for 1 week. The following week, DBE was performed again, and it was found that the stone had further softened, making attempts at fracture easier. Finally, the enterolith was almost completely fractured. Intestinal stenosis, probably due to ulcers caused by NSAIDs, was found. Small bowel obstruction with an enterolith is rare. In this case, it was considered that the seed could not pass through the stenotic region of the small intestine and the intestinal contents had gradually built up around it. It has been suggested that DBE may be a therapeutic option in cases of an enterolith. Further, cola dissolution therapy has been shown to be useful in treating an enterolith, with the possible explanation that cola undergoes an acid-base reaction with the enterolith. In summary, we report, for the first time, treatment of an enterolith with a combination of DBE and cola dissolution therapy, thereby avoiding surgery and its risks.
一位 71 岁的类风湿关节炎女性患者，长期服用非甾体抗炎药（NSAIDs），因腹痛就诊于我院。腹部 CT 扫描显示小肠口有肠石扩张，诊断为小肠梗阻。考虑到肠石是由于肠内容物停滞而逐渐增大形成的肠梗阻。我们进行了经口双气囊内镜（DBE）检查以观察和取出肠石。我们使用钳子和圈套器将肠石折断。在尝试过程中，我们发现肠石中心有一粒种子。由于肠石非常坚硬，我们从肠梗阻管给予可乐溶解疗法 1 周。第 2 周，再次进行 DBE 检查，发现结石进一步软化，更容易折断。最终，肠石几乎完全折断。发现肠狭窄，可能是 NSAIDs 引起的溃疡所致。小肠内有肠石梗阻较为罕见。在这种情况下，考虑到种子可能无法通过小肠狭窄部位，肠内容物逐渐在其周围堆积。有研究表明，DBE 可能是肠石的一种治疗选择。此外，可乐溶解疗法在治疗肠石方面也显示出一定的效果，其可能的解释是可乐与肠石发生酸碱反应。总之，我们首次报告了 DBE 联合可乐溶解疗法治疗肠石的病例，从而避免了手术及其风险。
