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Peer-reviewedCC BY 4.0Cureus

Multifocal Enterolithiasis Associated With Appendicitis and Colonic Diverticulosis Mimicking Gallstone Ileus: A Case Report

  • Mauro A Cardenas1
  • Violeta G Beltran Nuñez1
  • Roberto G Guzman Armendariz1
  • Angel Portilla1
  • Akemy H Tsuyi Loya2
  • Katia Ramírez Martínez1
  • Luis F Ochoa1
  • Valeria Muñoz Salas3
  • Jesus A Jacquez Graff4
  • Luis D Chavarria Muñoz5
  • Melisa Licon Meza6
  • Luisa F Peña Martinez5
9 more authors
  • Sergio Miguel Suárez Fuentes7
  • Jazmin Sáenz López8
  • Paola I Cárdenas Rosales9
  • Luis A Muñoz Sanchez10
  • Diana I Escalante Zamora11
  • Bruno A Guggiari12
  • Jose A Ojeda Valenzuela13
  • Mario Hernandez Mancillas14
  • Martín Rodríguez-Garza15
15 affiliations
  1. 1Surgery, Hospital General Presidente Lázaro Cárdenas del Rio Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Chihuahua, MEX
  2. 2General Surgery, Autonomous University of Chihuahua, Chihuahua, MEX
  3. 3Surgery, Autonomous University of Chihuahua, Chihuahua, MEX
  4. 4Research, NeuroteamCUU (Chihuahua), Chihuahua, MEX
  5. 5Surgery, Hospital General Presidente Lázaro Cárdenas del Rio, Chihuahua, MEX
  6. 6Surgery, Institute for Social Security and Services for State Workers, Chihuahua, MEX
  7. 7General Surgery, Hospital Regional Valentín Gómez Farías, Zapopan, MEX
  8. 8General Medicine, Autonomous University of Chihuahua, Chihuahua, MEX
  9. 9Medicine, Autonomous University of Chihuahua, Chihuahua, MEX
  10. 10Internal Medicine, Hospital General Dr. Salvador Zubirán Anchondo, Chihuahua, MEX
  11. 11Pediatric Medicine, Hospital Infantil de Especialidades de Chihuahua, Chihuahua, MEX
  12. 12Thoracic Surgery, Hospital Civil de Guadalajara, Guadalajara, MEX
  13. 13Surgery, Hospital Civil de Culiacán, Culiacán, MEX
  14. 14General Surgery, Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Zacetecas, MEX
  15. 15General Surgery, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Monterrey, MEX
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Abstract

Enterolithiasis is an uncommon condition that can present with nonspecific symptoms and pose a diagnostic challenge when concomitant cholelithiasis suggests gallstone ileus. We report the case of a 58-year-old woman who presented with abdominal pain, vomiting, and obstipation, with computed tomography findings initially suggestive of gallstone ileus. Exploratory laparotomy revealed no small-bowel obstruction or obstructing calculus. Instead, multiple calculi were identified within the appendix, and additional calculi were found impacted within diverticula throughout the colon, consistent with multifocal enterolithiasis. Appendectomy was performed, and the diverticular calculi were reduced into the intestinal lumen. Cholecystectomy was deferred because the biliary anatomy could not be safely identified. Histopathological examination demonstrated acute fibrinopurulent appendicitis and periappendicitis despite the absence of evident macroscopic inflammation. This case illustrates an unusual multifocal distribution of enteroliths involving the appendix and multiple colonic diverticula in a patient with concomitant cholelithiasis. It underscores the importance of integrating radiological findings with systematic intraoperative exploration when differentiating enterolithiasis from gallstone ileus.

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Cite

BibTeXRIS
BibTeX
@article{cardenas2026multifocal,
  title = {{Multifocal Enterolithiasis Associated With Appendicitis and Colonic Diverticulosis Mimicking Gallstone Ileus: A Case Report}},
  author = {Mauro A Cardenas and Violeta G Beltran Nuñez and Roberto G Guzman Armendariz and Angel Portilla and Akemy H Tsuyi Loya and Katia Ramírez Martínez and Luis F Ochoa and Valeria Muñoz Salas and Jesus A Jacquez Graff and Luis D Chavarria Muñoz and Melisa Licon Meza and Luisa F Peña Martinez and Sergio Miguel Suárez Fuentes and Jazmin Sáenz López and Paola I Cárdenas Rosales and Luis A Muñoz Sanchez and Diana I Escalante Zamora and Bruno A Guggiari and Jose A Ojeda Valenzuela and Mario Hernandez Mancillas and Martín Rodríguez-Garza},
  journal = {Cureus},
  year = {2026},
  month = sep,
  doi = {10.7759/cureus.116948},
  url = {https://doi.org/10.7759/cureus.116948},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Multifocal Enterolithiasis Associated With Appendicitis and Colonic Diverticulosis Mimicking Gallstone Ileus: A Case Report
AU  - Mauro A Cardenas
AU  - Violeta G Beltran Nuñez
AU  - Roberto G Guzman Armendariz
AU  - Angel Portilla
AU  - Akemy H Tsuyi Loya
AU  - Katia Ramírez Martínez
AU  - Luis F Ochoa
AU  - Valeria Muñoz Salas
AU  - Jesus A Jacquez Graff
AU  - Luis D Chavarria Muñoz
AU  - Melisa Licon Meza
AU  - Luisa F Peña Martinez
AU  - Sergio Miguel Suárez Fuentes
AU  - Jazmin Sáenz López
AU  - Paola I Cárdenas Rosales
AU  - Luis A Muñoz Sanchez
AU  - Diana I Escalante Zamora
AU  - Bruno A Guggiari
AU  - Jose A Ojeda Valenzuela
AU  - Mario Hernandez Mancillas
AU  - Martín Rodríguez-Garza
PY  - 2026
DA  - 2026/09/25
JO  - Cureus
DO  - 10.7759/cureus.116948
UR  - https://doi.org/10.7759/cureus.116948
AB  - Enterolithiasis is an uncommon condition that can present with nonspecific symptoms and pose a diagnostic challenge when concomitant cholelithiasis suggests gallstone ileus. We report the case of a 58-year-old woman who presented with abdominal pain, vomiting, and obstipation, with computed tomography findings initially suggestive of gallstone ileus. Exploratory laparotomy revealed no small-bowel obstruction or obstructing calculus. Instead, multiple calculi were identified within the appendix, and additional calculi were found impacted within diverticula throughout the colon, consistent with multifocal enterolithiasis. Appendectomy was performed, and the diverticular calculi were reduced into the intestinal lumen. Cholecystectomy was deferred because the biliary anatomy could not be safely identified. Histopathological examination demonstrated acute fibrinopurulent appendicitis and periappendicitis despite the absence of evident macroscopic inflammation. This case illustrates an unusual multifocal distribution of enteroliths involving the appendix and multiple colonic diverticula in a patient with concomitant cholelithiasis. It underscores the importance of integrating radiological findings with systematic intraoperative exploration when differentiating enterolithiasis from gallstone ileus.
SN  - 2168-8184
ER  -