A 42-year-old man with a history of Crohn’s disease was referred for treatment of an
enterolith. The patient had no symptoms such as abdominal pain or nausea. Abdominal X-ray and
computed tomography (CT) scan showed a 2.8-cm enterolith in the ileum ([Fig. 1], [Fig. 2]). Intestinal stenosis was found 10 cm proximal from the Bauhin’s valve with an
enterolith on the proximal side of the stenosis ([Fig. 3]). The stenosis was dilated with a balloon catheter. Because the enterolith often moved
into the oral side of the intestinal tract, retrograde double-balloon endoscopy (DBE) was
performed using an EI-580BT endoscope (Fujifilm, Tokyo, Japan). We tried to crush the stone
using biopsy forceps, polypectomy snares and crusher catheters, but the stone was too hard and
none were effective. Surgery or electrohydraulic lithotripsy (EHL) were suggested as treatment
options, and the patient chose EHL. We surrounded the stone with water, and EHL was performed
([Video 1]). The stone gradually cracked and fragmented into pieces ([Fig. 4]). We removed it using a disposable loop net ([Fig. 5]). Calculus analysis revealed that the main component of the enterolith was calcium
oxalate, which indicates that the stone was a true-enterolith.
Fig. 1 X-ray revealed a 2.8-cm stone in the lower abdomen.
Fig. 2 CT scan showed a 2.8-cm high absorption enterolith in the ileum.
Fig. 3 An enterolith was found on the proximal side of the stenosis.
Treatment of an enterolith using electrohydraulic lithotripsy by double-balloon
endoscopy. Video text: Retrograde double-balloon endoscopy was performed. Intestinal
stenosis was found 10 cm proximal from the Bauhin’s valve. The stenosis was dilated up to 15
mm with a balloon catheter. An enterolith was found on the proximal side of the stenosis. We
surrounded the stone with water. Electrohydraulic lithotripsy (EHL) was performed. The stone
gradually cracked, and finally split into two. Additional EHL was performed to further split
the stone. The stone was removed using a disposable loop net.Video 1
Fig. 4 The stone gradually cracked, and split into two.
Fig. 5 The stones removed from the ileum.
Performance of EHL for enterolith [1]
[2], and treatment of enteroliths by balloon-assisted enteroscopy using other endoscopic
devices [3] have been described. However, performance of EHL by double-balloon endoscopy for a
true-enterolith in the ileum is extremely rare [4], and surgery is often selected for treatment [5]. Use of EHL was successful in avoiding surgery for a true-enterolith that could not be
crushed with other endoscopic devices. Application of EHL could be
recommended as a less invasive option to treat enteroliths.
Conclusions
In summary, we report the treatment of a true-enterolith in a patient with Crohn’s disease
using electrohydraulic lithotripsy by retrograde DBE endoscopy, thereby avoiding
surgery.