Meckel’s diverticulum is the most common congenital abnormality in the gastrointestinal tract, occurring in 2% of the population, with a 4.2 –6.4% risk of complication . The omphalomesenteric duct is the point of original communication between the yolk sac and the bowel lumen, which typically closes during the 9th week of gestation. A Meckel’s diverticulum is formed when the proximal portion of the omphalomesenteric duct fails to completely obliterate.
Enteroliths within Meckel’s diverticulum are thought to be rare; however, the incidence is difficult to ascertain because its existence has only been documented in case reports. Primary enteroliths are thought to result from precipitation and deposition of enteric contents associated with hypomotility and stasis, whereas secondary enteroliths include foreign bodies that clump together and serve as a nidus for intestinal content deposition . It is thought that the alkaline environment of the small bowel favors precipitation . Enteroliths within or expelled from a Meckel’s diverticulum can be asymptomatic  or present with perforation , diverticulitis, or bowel obstruction . Including Fig. 3 in this study, only a few operative photos of enteroliths arising from Meckel’s diverticulum have been published .
Meckel’s diverticulum perforation is a serious and often life-threatening complication, usually secondary to diverticulitis, gangrene, or peptic ulceration due to ectopic gastric mucosa. Other various pathologies leading to perforation are Littre’s hernia and tumors such as leiomyosarcoma, lymphatic sarcoma, and poorly differentiated stromal tumors . Perforation of Meckel’s diverticulum by foreign bodies is extremely rare, and in a review, the indication rate for a resection due to perforation by a foreign body like fish bone and toothpick was reported to be 8% of all complicated diverticula . Chan et al. reported more than 300 cases of perforation of Meckel’s diverticulum by foreign body , and among them, cases of fish and chicken bone, wood splinter, and button battery have been mentioned in the literature [11, 12]. It is said that the tendency of these objects to lodge in the blind pouch of the Meckel’s diverticulum causes the perforation. In our present case, only a few cases of perforation at the site of the diverticulum with true enterolith formation like the calcium phosphate stone have been reported in the literature [13, 14]. One possible explanation of this rarity is that most Meckel’s diverticula have wide necks and contain smooth muscle capable of peristalsis . Therefore, stagnation and stasis of the intestinal contents is unlikely. The pathogenesis of true enterolith formation in Meckel’s diverticulum is unclear. It may be related to stasis resulting from poor coordination of the peristaltic wave at the site of the Meckel’s diverticulum . Also, superimposed inflammation and edema of the neck of the diverticulum could narrow the opening and decrease drainage, leading to precipitation and nidus formation of the true enterolith. Approximately one-third of enteroliths were radiopaque and therefore demonstrable radiographically like in our present case .
A symptomatic or complicated Meckel’s diverticulum diagnosis is difficult to confirm on the basis of history, physical examination, laboratory findings, and imaging because a variety of conditions mimic Meckel’s diverticulum both clinically and radiologically (such as appendicitis, ileal/colonic diverticulitis, or regional enteritis/colitis) . Traditionally, clinicians confronted with a patient with complicated Meckel’s diverticulum relied on conventional gastrointestinal contrast studies, angiography, or scintigraphy. However, these methods have been progressively replaced by CT, which is now routinely used as the first-line imaging tool in the diagnostic workup of the acute abdomen . The sensitivity of diagnosing Meckel’s diverticulum on CT scan has increased owing to the availability of higher spatial resolution and the multiplanar isotropic reconstruction ability of the latest Meckel’s diverticulum CT scanners, which allow visualization of the small bowel in various planes .
Management of symptomatic or complicated Meckel’s diverticulum is generally through open or laparoscopic resection of the diverticulum. With respect to this specific complication, several approaches have been described, including milking the enterolith distally into the cecum or proximally into a healthy small bowel and performing an enterotomy to extract it . Alternatively, resection of the segment of the small bowel containing the Meckel’s diverticulum and enterolith followed by primary anastomosis can be performed . In this case, a single-port laparoscopic procedure successfully confirmed and resected the Meckel’s diverticulum with enterolith.