Advertisement

Japanese Journal of Radiology

, Volume 37, Issue 4, pp 301–307 | Cite as

Clinical and CT findings of small bowel obstruction caused by rice cakes in comparison with bezoars

  • Shigehiro SugimotoEmail author
  • Taro Shimono
  • Tohru Takeshita
  • Akira Yamamoto
  • Daisuke Shindo
  • Yukio Miki
Original Article
  • 74 Downloads

Abstract

Purpose

Rice cakes have not been recognized as a cause of small bowel obstruction (SBO) worldwide. We compared clinical and CT findings of rice cake SBO versus SBO due to bezoars, the most common cause of food-induced SBO.

Methods

Twenty-four patients with rice cake SBO (n = 17) or bezoar SBO (n = 7) were retrospectively evaluated for clinical findings and the following multi-detector CT (MDCT) features: identification of the transition zone, presence of intraluminal lesions, degree of obstruction, and length and attenuation of obstructing materials. Categorical variables were compared by Fisher’s exact test, and continuous variables by independent t test.

Results

None of the rice cake SBO patients required surgery, whereas 4/7 (57%) bezoar SBO patients underwent surgery. On MDCT, rice cake residues were recognized as well-defined intraluminal lesions of shorter length (29.8 ± 4.6 mm vs. 47.7 ± 10.8 mm for bezoars; p < 0.0001) and higher attenuation (106 ± 27.8 HU vs. − 62.8 ± 14.7 HU for bezoars; p < 0.0001).

Conclusions

Rice cake SBO patients did not require surgery. On MDCT, rice cake residues were significantly shorter and higher in attenuation than bezoars. These findings facilitate diagnosis and support the conservative management of rice cake SBO.

Keywords

Rice cake Bezoar Small bowel obstruction Food-induced small bowel obstruction Multi-detector CT 

Notes

Funding

No funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

Informed consent was waived because of the retrospective nature of our study with pre-existing data. This study was approved by our institutional research board. We declare that all human studies have been performed in accordance with the ethical standards laid down in the 1964 Helsinki declaration and its later amendments.

References

  1. 1.
    Miller G, Boman J, Shrier I, Gordon PH. Etiology of small bowel obstruction. Am J Surg. 2000;180:33–6.CrossRefGoogle Scholar
  2. 2.
    Bedioui H, Daghfous A, Ayadi M, Noomen R, Chebbi F, Rebai W, et al. A report of 15 cases of small-bowel obstruction secondary to phytobezoars: predisposing factors and diagnostic difficulties. Gastroenterol Clin Biol. 2008;32:596–600.CrossRefGoogle Scholar
  3. 3.
    Lazarus DE, Slywotsky C, Bennett GL, Megibow AJ, Macari M. Frequency and relevance of the "small-bowel feces" sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol. 2004;183:1361–6.CrossRefGoogle Scholar
  4. 4.
    Ko S, Lee T, Ng S. Small bowel obstruction due to phytobezoar: CT diagnosis. Abdom Imaging. 1997;22:471–3.CrossRefGoogle Scholar
  5. 5.
    Quiroga S, Alvarez-Castells A, Sebastià MC, Pallisa E, Barluenga E. Small bowel obstruction secondary to bezoar: CT diagnosis. Abdom Imaging. 1997;22:315–7.CrossRefGoogle Scholar
  6. 6.
    Delabrousse E, Brunelle S, Saguet O, Destrumelle N, Landecy G, Kastler B. Small bowel obstruction secondary to phytobezoar. Clin Imaging. 2001;25:44–6.CrossRefGoogle Scholar
  7. 7.
    Yildirim T, Yildirim S, Barutcu O, Oguzkurt L, Noyan T. Small bowel obstruction due to phytobezoar: CT diagnosis. Eur Radiol. 2002;12:2659–61.Google Scholar
  8. 8.
    Kim JH, Ha HK, Sohn MJ, Kim AY, Kim TK, Kim PN, et al. CT findings of phytobezoar associated with small bowel obstruction. Eur Radiol. 2003;13:299–304.CrossRefGoogle Scholar
  9. 9.
    Zissin R, Osadchy A, Gutman V, Rathaus V, Shapiro-Feinberg M, Gayer G. CT findings in patients with small bowel obstruction due to phytobezoar. Emerg Radiol. 2004;10:197–200.CrossRefGoogle Scholar
  10. 10.
    de Toledo AP, Rodrigues FH, Rodrigues MR, Sato DT, Nonose R, Nascimento EF, et al. Diospyrobezoar as a cause of small bowel obstruction. Case Rep Gastroenterol. 2012;6:596–603.CrossRefGoogle Scholar
  11. 11.
    Wang PY, Wang X, Zhang L, Li HF, Chen L, Wang X, et al. Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography. World J Gastroenterol. 2015;21:9774–84.CrossRefGoogle Scholar
  12. 12.
    Ihara N, Yashiro N, Kinoshita T, Yoshigi J, Kasai T. Small bowel obstruction due to pickled Japanese apricot: CT findings. J Comput Assist Tomogr. 2002;26:132–3.CrossRefGoogle Scholar
  13. 13.
    Satake R, Chinda D, Shimoyama T, Satake M, Oota R, Sato S, et al. Repeated small bowel obstruction caused by chestnut ingestion without the formation of phytobezoars. Intern Med. 2016;55:1565–8.CrossRefGoogle Scholar
  14. 14.
    Baba A, Okuyama Y, Kimura K, Mogami T. Small bowel obstruction due to rice cake (mochi). Intern Med. 2016;55:1933–4.CrossRefGoogle Scholar
  15. 15.
    Miura T, Kimura N, Nakamura J, Yamada S, Miura T, Yanagi M, et al. Rice cake ileus—a rare and ethnic but important disease status in east-southern Asia. Intern Med. 2011;50:2737–9.CrossRefGoogle Scholar
  16. 16.
    Oka A, Amano Y, Uchida Y, Kagawa K, Takatori K, Kitajima N, et al. Small bowel obstruction and gastric ulceration resulting from rice cake ingestion—computed tomography diagnosis in eight patients. Nihon Shokakibyo Gakkai Zasshi. 2013;110:1804–13.Google Scholar
  17. 17.
    Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics. 2009;29:423–39.CrossRefGoogle Scholar
  18. 18.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefGoogle Scholar
  19. 19.
    Hamaguchi J, Abe H, Matsuzawa F, Mizukami T, Hirokata G, et al. A case of small bowel obstruction induced by dietary tangle. J Jpn Surg Assoc. 2013;74:1876–81.CrossRefGoogle Scholar
  20. 20.
    Kobayashi M, Mizuno M, Yoshida S, Sasaki S, Arisue A, et al. Two cases of small bowel obstruction due to kelp candy impaction requiring abdominal surgery. J Jpn Soc Pediatr Surg. 2014;50:267–72.Google Scholar
  21. 21.
    Iwamuro M, Tanaka S, Shiode J, Imagawa A, Mizuno M, Fujiki S, et al. Clinical characteristics and treatment outcomes of nineteen Japanese patients with gastrointestinal bezoars. Intern Med. 2014;53:1099–105.CrossRefGoogle Scholar
  22. 22.
    Samdani T, Singhal T, Balakrishnan S, Hussain A, Grandy-Smith S, El-Hasani S. An apricot story: view through a keyhole. World J Emerg Surg. 2007;2:20.CrossRefGoogle Scholar
  23. 23.
    Chen YC, Liu CH, Hsu HH, Yu CY, Wang HH, Fan HL, et al. Imaging differentiation of phytobezoar and small-bowel faeces: CT characteristics with quantitative analysis in patients with small-bowel obstruction. Eur Radiol. 2015;25:922–31.CrossRefGoogle Scholar

Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyOsaka City University Graduate School of MedicineOsakaJapan

Personalised recommendations