To the Editor.-A 70-year-old woman had symptoms and findings typical of small bowel obstruction. Previously she had had a hysterectomy, appendectomy, fractured cervical spine, cholecystectomy, fractured hip, and parkinsonism for 15 years. She also had had upper gastrointestinal tract and barium enema x-ray studies that were unremarkable. She had been taking 2,500 mg of levodopa daily.
A mass, described as a "huge balllike fecal impaction," could be palpated rectally and vaginally. The abdomen was distended and tympanitic. A flat plate of the abdomen showed dilated loops of small bowel measuring up to 6 cm in diameter with airfluid levels. Nasogastric suction was instituted and the returns were fecal.
At laparotomy, distended loops of small bowel and a large egg-shaped intraluminal obstruction in the distal ileum were encountered. An antimesenteric enterotomy was made, and the large calculus removed. The enterotomy was closed without resection. Postoperatively, bowel function resumed rapidly.