Dietary small bowel obstruction.

To cite: Kusumoto M, Koganemaru M, Nakayama G, et al. BMJ Case Reports Published online: [please include Day Month Year] doi:10.1136/ bcr-2012-007950 DESCRIPTION A 59-year-old man with no history of abdominal or intestinal surgery, trauma or psychiatric illness presented to our hospital with abdominal pain and vomiting. Physical examination revealed hyperactive bowel sounds and lower abdominal tenderness. Abdominal CT revealed a small bowel obstruction in the lower abdominal space, possibly due to obstruction of the fusiform low attenuation (–162 Hounsfield units) region (figure 1, arrows), and suspected ileal stricture on the anal side of the low-attenuation region. The region was similar to that of fat to air attenuation. Insertion of a nasogastric tube did not improve his condition, blood pressure decreased, and his symptoms were ingravescent. Emergency surgery was conducted to release the obstruction. Operative and pathological findings revealed mucosal damage and necrosis in the small intestine with no ileal stricture and adhesion; approximately 50 cm of the affected region was resected and an ingested 7.5 cm diameter shiitake mushroom was found (figure 2). The small bowel obstruction disappeared upon removal of the mushroom and the patient was discharged on postoperative day 17. Given that mushrooms are rich in fibre, they absorb consumed oils, intestinal fluids and intestinal gases, and show very low attenuation on CT. Moreover, as in the present case, unintentionally swallowing one whole can cause bowel obstruction. Bowel obstruction most likely occurs in the small