{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T08:56:52Z","timestamp":1769331412413,"version":"3.49.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["surg case rep"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>True primary enterolithiasis is an uncommon condition, and nontraumatic perforation of the small intestine (NTPSI) is also an unusual entity. Therefore, NTPSI due to true primary enteroliths is an exceptionally rare complication. Moreover, enterolithiasis and radiation enteritis are also unique combinations. Herein, we present an exceedingly rare case of NTPSI induced by multiple true primary enteroliths associated with radiation enteritis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 92-year-old woman with acute abdominal pain was transferred to our hospital because a computed tomography (CT) scan performed by her family doctor revealed free air and fluid collection within her abdomen. Our initial diagnosis was upper gastrointestinal perforation, and we selected nonoperative management (NOM) with adnominal drainage. Although her general condition was stable, jejunal juice was drained continuously. Given that the CT performed 10\u00a0days after onset demonstrated perforation of the small intestine and adjacent concretion, we performed an emergency partial resection of the small intestine and jejunostomy. The resected bowel was 1\u00a0m in length and had many strictures that contained multiple enteroliths in their proximal lumens. The patient\u2019s postoperative course was uneventful. The enteroliths were composed of deoxycholic acid (DCA). She was diagnosed with peritonitis due to NTPSI derived from multiple true primary enteroliths associated with radiation enteritis, as she had previously undergone hysterectomy and subsequent internal radiation therapy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Clinicians should consider the rare entity of true primary enteroliths associated with radiation enteritis in NTPSI cases with unknown etiologies.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40792-021-01182-y","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T12:08:05Z","timestamp":1619179685000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Nontraumatic perforation of the small intestine caused by true primary enteroliths associated with radiation enteritis: a case report"],"prefix":"10.1186","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3392-5910","authenticated-orcid":false,"given":"Yusuke","family":"Hirakawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirona","family":"Shigyo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuriko","family":"Katagiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuaki","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mitsuru","family":"Katsumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Tomoeda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiko","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"issue":"5","key":"1182_CR1","first-page":"387","volume":"95","author":"S Grettve","year":"1947","unstructured":"Grettve S. A contribution to the knowledge of primary true concrements in the small bowel. Acta Chir Scand. 1947;95(5):387\u2013410.","journal-title":"Acta Chir Scand"},{"key":"1182_CR2","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1002\/bjs.18004720405","volume":"47","author":"JD Atwell","year":"1960","unstructured":"Atwell JD, Pollock AV. Intestinal calculi. Br J Surg. 1960;47:367\u201374.","journal-title":"Br J Surg"},{"issue":"46","key":"1182_CR3","first-page":"1017","volume":"49","author":"NA Kimchi","year":"2002","unstructured":"Kimchi NA, Broide E, Shapiro M, Scapa E. Non-traumatic perforation of the small intestine. Report of 13 cases and review of the literature. Hepatogastroenterology. 2002;49(46):1017\u201322.","journal-title":"Hepatogastroenterology."},{"issue":"5","key":"1182_CR4","first-page":"405","volume":"150","author":"CE Leijonmarck","year":"1984","unstructured":"Leijonmarck CE, Fenyo G, Raf L. Nontraumatic perforation of the small intestine. Acta Chir Scand. 1984;150(5):405\u201311.","journal-title":"Acta Chir Scand"},{"issue":"29","key":"1182_CR5","doi-asserted-by":"publisher","first-page":"9990","DOI":"10.3748\/wjg.v20.i29.9990","volume":"20","author":"HJ Freeman","year":"2014","unstructured":"Freeman HJ. Spontaneous free perforation of the small intestine in adults. World J Gastroenterol. 2014;20(29):9990\u20137.","journal-title":"World J Gastroenterol"},{"issue":"47","key":"1182_CR6","doi-asserted-by":"publisher","first-page":"17819","DOI":"10.3748\/wjg.v20.i47.17819","volume":"20","author":"GE Gurvits","year":"2014","unstructured":"Gurvits GE, Lan G. Enterolithiasis. World J Gastroenterol. 2014;20(47):17819\u201329.","journal-title":"World J Gastroenterol"},{"key":"1182_CR7","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1007\/BF02232778","volume":"7","author":"RA Norton","year":"1962","unstructured":"Norton RA, Mahowald TA, Monroe LS. Radiation jejunitis and a choleic-acid enterolith. Report of a case. Am J Dig Dis. 1962;7:634\u201341.","journal-title":"Am J Dig Dis."},{"issue":"5","key":"1182_CR8","first-page":"432","volume":"82","author":"ML Paige","year":"1987","unstructured":"Paige ML, Ghahremani GG, Brosnan JJ. Laminated radiopaque enteroliths: diagnostic clues to intestinal pathology. Am J Gastroenterol. 1987;82(5):432\u20137.","journal-title":"Am J Gastroenterol"},{"issue":"19","key":"1182_CR9","doi-asserted-by":"publisher","first-page":"2439","DOI":"10.2169\/internalmedicine.54.5208","volume":"54","author":"M Ishioka","year":"2015","unstructured":"Ishioka M, Jin M, Matsuhashi T, Arata S, Suzuki Y, Watanabe N, et al. True primary enterolith treated by balloon-assisted enteroscopy. Intern Med. 2015;54(19):2439\u201342.","journal-title":"Intern Med"},{"issue":"3","key":"1182_CR10","first-page":"273","volume":"101","author":"M van Hillo","year":"1987","unstructured":"van Hillo M, van der Vliet JA, Wiggers T, Obertop H, Terpstra OT, Greep JM. Gallstone obstruction of the intestine: an analysis of ten patients and a review of the literature. Surgery. 1987;101(3):273\u20136.","journal-title":"Surgery"},{"issue":"1","key":"1182_CR11","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1007\/BF00311997","volume":"26","author":"Y Tatekawa","year":"1996","unstructured":"Tatekawa Y, Nakatani K, Ishii H, Paku S, Kasamatsu M, Sekiya N, et al. Small bowel obstruction caused by a medication bezoar: report of a case. Surg Today. 1996;26(1):68\u201370.","journal-title":"Surg Today"},{"issue":"1","key":"1182_CR12","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/s40792-020-00926-6","volume":"6","author":"T Shimagaki","year":"2020","unstructured":"Shimagaki T, Konishi K, Kawata K, Edahiro K, Edagawa M, Takenaka T, et al. A case of perforation of Meckel\u2019s diverticulum with enterolith. Surg Case Rep. 2020;6(1):161.","journal-title":"Surg Case Rep"},{"issue":"628","key":"1182_CR13","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1259\/0007-1285-53-628-365","volume":"53","author":"GN Athey","year":"1980","unstructured":"Athey GN. Unusual demonstration of a Meckel\u2019s diverticulum containing enteroliths. Br J Radiol. 1980;53(628):365\u20138.","journal-title":"Br J Radiol"},{"issue":"10","key":"1182_CR14","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1007\/BF02049713","volume":"34","author":"PV Lopez","year":"1991","unstructured":"Lopez PV, Welch JP. Enterolith intestinal obstruction owing to acquired and congenital diverticulosis. Report of two cases and review of the literature. Dis Colon Rectum. 1991;34(10):941\u20134.","journal-title":"Dis Colon Rectum."},{"issue":"5","key":"1182_CR15","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/S0039-6060(97)90349-4","volume":"122","author":"CK Leow","year":"1997","unstructured":"Leow CK, Lau WY. Treatment of small bowel obstruction by jejunal enterolith. Surgery. 1997;122(5):977\u20138.","journal-title":"Surgery"},{"issue":"6","key":"1182_CR16","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1001\/archsurg.1967.01330180046008","volume":"95","author":"D Kia","year":"1967","unstructured":"Kia D, Dragstedt LR 2nd. Enterolithiasis associated with side-to-side intestinal anastomosis. Arch Surg. 1967;95(6):898\u2013901.","journal-title":"Arch Surg"},{"issue":"4","key":"1182_CR17","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1148\/radiographics.13.4.8356285","volume":"13","author":"FM Gin","year":"1993","unstructured":"Gin FM, Maglinte DD, Chua GT. General case of the day. Enterolith in a blind pouch (blind pouch syndrome secondary to side-to-side enteroanastomosis). Radiographics. 1993;13(4):965\u20137.","journal-title":"Radiographics"},{"issue":"11","key":"1182_CR18","doi-asserted-by":"publisher","first-page":"3214","DOI":"10.1007\/s10620-006-9097-1","volume":"52","author":"WS Tan","year":"2007","unstructured":"Tan WS, Chung AY, Low AS, Cheah FK, Ong SC. Enterolith formation in the roux limb hepaticojejunostomy. Dig Dis Sci. 2007;52(11):3214\u20136.","journal-title":"Dig Dis Sci"},{"issue":"7","key":"1182_CR19","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1111\/hepr.12401","volume":"45","author":"S Mukai","year":"2015","unstructured":"Mukai S, Onoe T, Tashiro H, Ohdan H. Small bowel obstruction due to an unconjugated ursodeoxycholic acid enterolith following living donor liver transplantation: report of a case. Hepatol Res. 2015;45(7):818\u201322.","journal-title":"Hepatol Res"},{"key":"1182_CR20","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.ijscr.2018.06.005","volume":"50","author":"K Sato","year":"2018","unstructured":"Sato K, Banshodani M, Nishihara M, Nambu J, Kawaguchi Y, Shimamoto F, et al. Afferent loop obstruction with obstructive jaundice and ileus due to an enterolith after distal gastrectomy: a case report. Int J Surg Case Rep. 2018;50:9\u201312.","journal-title":"Int J Surg Case Rep"},{"issue":"6","key":"1182_CR21","first-page":"457","volume":"109","author":"AR Alves","year":"2017","unstructured":"Alves AR, Almeida N, Ferreira M, Tome L. Endoscopic management of afferent loop syndrome caused by enteroliths and anastomotic stricture. A case report. Rev Esp Enferm Dig. 2017;109(6):457.","journal-title":"Rev Esp Enferm Dig."},{"issue":"1","key":"1182_CR22","first-page":"29","volume":"5","author":"NM Gupta","year":"1986","unstructured":"Gupta NM, Pinjla RK, Talwar BL. Calcific enterolithiasis. Indian J Gastroenterol. 1986;5(1):29\u201330.","journal-title":"Indian J Gastroenterol"},{"issue":"10","key":"1182_CR23","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1007\/s12098-009-0221-z","volume":"76","author":"D Mishra","year":"2009","unstructured":"Mishra D, Singh S, Juneja M. Enterolithiasis: an uncommon finding in abdominal tuberculosis. Indian J Pediatr. 2009;76(10):1049\u201350.","journal-title":"Indian J Pediatr"},{"issue":"2","key":"1182_CR24","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1159\/000330842","volume":"5","author":"R Nonose","year":"2011","unstructured":"Nonose R, Valenciano JS, de Souza Lima JS, Nascimento EF, Silva CM, Martinez CA. Jejunal diverticular perforation due to enterolith. Case Rep Gastroenterol. 2011;5(2):445\u201351.","journal-title":"Case Rep Gastroenterol"},{"issue":"8","key":"1182_CR25","first-page":"895","volume":"95","author":"T Tsukamoto","year":"1998","unstructured":"Tsukamoto T, Hasegawa I, Ohta Y, Hamba H, Kubo S, Hirohashi K, et al. Perforated duodenal diverticulum caused by enterolith. Nihon Shokakibyo Gakkai Zasshi. 1998;95(8):895\u20139.","journal-title":"Nihon Shokakibyo Gakkai Zasshi"},{"key":"1182_CR26","doi-asserted-by":"publisher","first-page":"bcr2014203833","DOI":"10.1136\/bcr-2014-203833","volume":"2014","author":"B Chaudhery","year":"2014","unstructured":"Chaudhery B, Newman PA, Kelly MD. Small bowel obstruction and perforation secondary to primary enterolithiasis in a patient with jejunal diverticulosis. BMJ Case Rep. 2014;2014:bcr2014203833.","journal-title":"BMJ Case Rep."},{"issue":"3","key":"1182_CR27","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1007\/BF02938207","volume":"150","author":"RG Watson","year":"1981","unstructured":"Watson RG, Williams TD. Enterolith with pseudogallstone ileus and perforation. Ir J Med Sci. 1981;150(3):86\u20138.","journal-title":"Ir J Med Sci"},{"issue":"6","key":"1182_CR28","first-page":"662","volume":"72","author":"RM Zeit","year":"1979","unstructured":"Zeit RM. Enterolithiasis associated with ileal perforation in Crohn\u2019s disease. Am J Gastroenterol. 1979;72(6):662\u20134.","journal-title":"Am J Gastroenterol"},{"key":"1182_CR29","unstructured":"Mischinger HJ, Berger A, Kronberger L, Fellbaum C. Spontaneous small bowel perforation. A rare cause of acute abdomen. Acta Chir Scand. 1989;155(11\u201312):593\u20139."},{"issue":"10","key":"1182_CR30","doi-asserted-by":"publisher","first-page":"650","DOI":"10.3855\/jidc.829","volume":"4","author":"BK Jain","year":"2010","unstructured":"Jain BK, Arora H, Srivastava UK, Mohanty D, Garg PK. Insight into the management of non-traumatic perforation of the small intestine. J Infect Dev Ctries. 2010;4(10):650\u20134.","journal-title":"J Infect Dev Ctries"}],"container-title":["Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40792-021-01182-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40792-021-01182-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40792-021-01182-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T12:10:25Z","timestamp":1619179825000},"score":1,"resource":{"primary":{"URL":"https:\/\/surgicalcasereports.springeropen.com\/articles\/10.1186\/s40792-021-01182-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,23]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1182"],"URL":"https:\/\/doi.org\/10.1186\/s40792-021-01182-y","relation":{},"ISSN":["2198-7793"],"issn-type":[{"value":"2198-7793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,23]]},"assertion":[{"value":"17 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval consent to participate"}},{"value":"The patient provided written informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there are no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"102"}}