A Calcium Enterolith in a Patient with Crohn’s Disease and Its In Vitro Dissolubility in Citric Acid

Abstract

The microstructure and dissolubility of a calcified enterolith and enterolith pieces removed from a 26-year-old Japanese woman with Crohn's disease were analyzed using scanning electron microscopy and energy dispersive X-ray spectroscopy. The enterolith showed a multilayered structure with fatty acid calcium and magnesium phosphate. The amount of calcium, magnesium, and phosphate decreased after they were immersed in a citric acid solution, suggesting a potential contribution of acidic aqueous solution to elute inorganic substances contained in calcified enteroliths. This is the first study to investigate the in vitro dissolubility of calcified enteroliths induced by citric acid solution.

Cola Dissolution Therapy via Ileus Tube Was Effective for Ileus Secondary to Small Bowel Obstruction Induced by an Enterolith

“…4C). An analysis revealed that they consisted of calcium phosphate, bilirubin calcium, and cholesterol, which were consistent with the ingredients of an enterolith, as described in previous reports (9,10), but not those of a bezoar. To determine whether or not the calculi could be dissolved in solvents other than cola, 5-mg samples were placed in 20 mL of each of the following solvents at 25℃: Coca-Cola Ⓡ (pH 1.9), carbonated water (pH 3.6), and purified water (pH 7.0).…”

“…Furthermore, calcium phosphate is formed in an alkaline environment, as mentioned above. Indeed, previous studies reported that calcium phosphate was a component of enteroliths (9,22). In our case, we did not detect a biliary-enteric fistula.…”

“…Iwamuro reported that enteroliths removed surgically from patients with Crohn's disease could be dissolved by citric acid (9). In order to investigate whether or not an acid-base reaction was involved in the dissolution of enterolith fragments in this study, we assessed their dissolution in several solvents: 0.10 mol/L HCl (pH 1.0), 0.010 mol/L HCl (pH 2.0), and food-grade vinegar (pH 2.6), the last of which contains acetic acid.…”

Single large enterolith in a cat with chronic inflammatory enteropathy

“…Primary enteroliths form in areas of bowel stasis; causes of which that have been reported in human medical literature include intestinal diverticula (e.g., Meckel's diverticulum), surgical side-to-side enteroanastomoses, blind pouches, incarcerated hernias, intestinal kinking due to intra-abdominal adhesions, small intestinal tumours, and stenosing or stricturing Crohn's disease. 1,11,[17][18][19][20][21][22][23] Primary true enterolithiasis in human patients with unremarkable medical history is extremely rare. 24 Single enteroliths less than 2 cm have been reported to pass without complication in people, but if retained may become a nidus for additional deposition of mineral.…”

“…1 Patients often develop clinical signs of acute or subacute small bowel mechanical obstruction, including nausea, vomiting, abdominal pain and/or distension and constipation. 1,11,[17][18][19][20][21][22][23] The symptoms can be fluctuating in nature, as the enterolith passes through the gastrointestinal tract. 1,20 Our case had longstanding clinical signs of chronic vomiting and weight loss, with no specific inciting cause and without an acute component to suggest gastrointestinal obstruction.…”