Stones, Crohn's disease and Meckel's diverticulum.

Multiple faceted radio-opaque stones within the abdomen are usually situated in the gall bladder, and the incidence of gall stones is increased in patients with Crohn's disease.' Enteroliths may rarely be found in a Meckel's diverticulum,2 and there is an increased-incidence of Meckel's diverticulum in Crohn's disease.3 Stones in a Meckel's diverticulum associated with Crohn's disease have not been reported, but we describe such a case. A 62-year-old man presented on 19 December 1974 with a two-week history of intermittent central abdominal pain radiating to the right hypo-chondrium. His only other symptoms were slight constipation and nocturia. He had a tender mobile mass in the right iliac fossa, but, apart from an enlarged prostate, no other abnormality was found. In view of this mass, a barium enema was performed on 23 December. Initial screening disclosed several flat, triangular, laminated stones in the right side of the abdomen, with two further stones in the left iliac fossa. The calibre and haustral pattern of the large bowel were normal throughout. The terminal ileum was abnormal, showing some dilatation with loss of mucosal pattern (see figure). Postevacuation barium enema film showing stones in the Meckel's diverticulum and Crohn's disease of the terminal ileum. An erect film showed an air-fluid level at the site of the collection of stones. The films were interpreted as showing gallstones with a fistula between the gall bladder and small bowel, with two stones in the ileum, associated with terminal ileitis, probably due to Crohn's disease. The results of routine haematological investigations were normal, and the patient was admitted for laparotomy and cholecystectomy. Laparotomy, performed on 10 January 1975 via a right paramedian incision, showed a thickened gall bladder, but no stones were palpable; a large inflamed Meckel's diverticulum, containing multiple stones; and grossly thickened terminal ileum and its mesentery, characteristic of Crohn's disease. A modified right hemicolectomy was performed, removing the Meckel's diverticulum and the terminal ileum, with end-to-end anastomosis. The two stones seen in the left iliac fossa were not found. Apart from urinary infection and retention, he made a good postoperative recovery. The Meckel's diverticulum contained numerous flat triangular stones. Histologically it contained both gastric and small bowel mucosa, but there was no evidence of Crohn's disease in the diverticulum. The terminal ileum showed chronic inflammatory infiltration with mucosal ulceration, fissuring, and subserosal lymphoid aggregates, typical of Crohn's disease. Analysis of the stones showed a central …