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To the Editor.-A 70-year-old woman had symptoms and findings typical of small bowel obstruction. Previously she had had a hysterectomy, appendectomy, fractured cervical spine, cholecystectomy, fractured hip, and parkinsonism for 15 years. She also had had upper gastrointestinal tract and barium enema x-ray studies that were unremarkable. She had been taking 2,500 mg of levodopa daily.
A mass, described as a "huge balllike fecal impaction," could be palpated rectally and vaginally. The abdomen was distended and tympanitic. A flat plate of the abdomen showed dilated loops of small bowel measuring up to 6 cm in diameter with airfluid levels. Nasogastric suction was instituted and the returns were fecal.
At laparotomy, distended loops of small bowel and a large egg-shaped intraluminal obstruction in the distal ileum were encountered. An antimesenteric enterotomy was made, and the large calculus removed. The enterotomy was closed without resection. Postoperatively, bowel function resumed rapidly.
Falk VS. Enterolith Small Bowel Obstruction (Pseudogallstone Ileus). Arch Surg. 1974;108(5):749. doi:10.1001/archsurg.1974.01350290111024