Abstract
<title>Abstract</title> <p>Introduction Enterolithiasis is an uncommon clinical condition characterised by the formation or migration of calculi within the intestinal lumen. Clinical manifestations range from incidental findings to life-threatening mechanical intestinal obstruction. Owing to its rarity, existing evidence is largely limited to isolated case reports. Materials and Methods A retrospective case series of six patients diagnosed with enterolithiasis and managed at a tertiary gastrointestinal surgery center between 2019 and 2022 was performed in accordance with the PROCESS 2023 guidelines. Clinical presentation, radiological findings, operative details, histopathology, and post-procedural outcomes were systematically analysed. Results Six female patients with a median age of 57 years (range: 36–67 years) were identified. Four patients presented with acute small bowel obstruction, one with recurrent abdominal pain, and one with gastric outlet obstruction. Primary and secondary aetiologies included intestinal tuberculosis (n = 1), non-specific inflammatory ileal strictures (n = 1), idiopathic enterolithiasis (n = 1), and gallstone ileus secondary to a cholecystoduodenal fistula (n = 3). Notably, one case of ileal stricture enterolithiasis co-existed with an incidental low-grade appendicular mucinous neoplasm (LAMN), while another secondary gallstone ileus triggered acute retrograde gastric compartment syndrome resulting in total gastrectomy. Five patients underwent definitive surgical intervention, while one was managed conservatively but was subsequently lost to follow-up. One postoperative mortality occurred on postoperative day 6 due to sudden cardiac arrest. Conclusion Enterolithiasis remains a rare but highly significant cause of acute intestinal obstruction. Contrast-enhanced computed tomography facilitates early diagnosis and operative planning. Definitive treatment should be tailored according to the underlying pathology, patient physiology, and anatomical constraints.</p>