True Primary “Idiopathic” Enterolithiasis as an Unusual Cause of Bowel Perforation

Enterolithiasis, i.e. presence of stones within the intestinal tract, is a rare entity. Enteroliths could be primary (formed within the intestine) or secondary (such as gallstones and urinary stones, formed outside and migrating into intestinal tract through a fistula). Primary stones may be true (formed by precipitation of contents of chyme) or false (formed from insoluble foreign substances, such as bezoars).1 True primary enteroliths are usually associated with conditions leading to stasis such as strictures/stenosis (due to tuberculosis, Crohn’s disease, radiation, malignancy etc.), diverticula, postoperative stasis (roux loops, Billroth II gastrojejunostomy, blind pouches etc.) and medications (Calcium, diltiazem, levodopa, ursodeoxycholic acid ).1 Rare cases may arise in absence of known predisposing factors. We propose a new category, i.e. “Idiopathic true primary enteroliths”, for cases where cause remains obscure despite complete evaluation. Extensive search revealed only few such cases in medical literature. Moreover, idiopathic enterolith causing bowel perforation is even rarer, with only three reports worldwide.2,3,4 We describe an idiopathic true primary enterolith resulting in ileal perforation in otherwise normal gut. Also, a brief review of previously reported idiopathic enteroliths has been discussed.