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Histology confirmed this to be an enterolith adherent to the pouch. Our patient had a follow up evacuating pouchogram which showed stasis in the pouch. Food residue chronically accumulating would act as a nidus for enterolith formation. Morphological abnormalities of the pouch such as twist or mucosal bridge may have a role. We would recommend regular pouch washouts to prevent accumulation of residue and recurrent enterolith formation. Pouch patients may develop transient symptoms of frequency, incontinence, and leakage during pregnancy but these do settle after delivery. Persistent or new symptoms after delivery should be investigated. Plain x rays, computed tomography scan, endoscopy, or examination under anaesthesia help to confirm the diagnosis. Removal of the enterolith can be attempted endoscopically or transanally. Laparotomy may become necessary and access into the pouch may be gained by incising the fundus. These patients require a period of follow up and an evacuating pouchogram to ensure return of good pouch function.

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