CASE 9347 Published on 23.06.2011

Unusual cause of intestinal obstruction

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Heinze A, Hoeschel M

Patient

60 years, male

Categories
Area of Interest Abdomen ; Imaging Technique CT, Conventional radiography
Clinical History
A 60-year-old patient with vomiting but not the complete signs of obstruction was admitted. However, an abdominal ultrasound showed a small bowel obstruction. CT showed obstruction of the small bowel with an intestinal foreign body. With worsening of the vomiting and the clinical status a laparotomy was performed.
Imaging Findings
An abdominal x-ray showed an unidentifiable structure. CT revealed dilated small bowel and an intraluminal foreign body as the most probable cause of obstruction. It had a size of 5, 7 x 1, 6 cm, a linear configuration, and a density of -160 HU. The wall of the small bowel was thickened (6mm). The prestenotic bowel loop was dilated and the bowel distal to the foreign body was collapsed. A classic phytobezoar as cause of obstruction was ruled out as was an ingested foreign body due to drug-smuggling as this patient lived in a nursing home. A nutritional artifact like a banana or a sausage was thought of but ruled out to be too unusual. The imaging features were presented to the surgeon and a laparotomy was performed. Intraoperatively an intraluminal small gherkin (cucumber) was found as the cause of the small bowel obstruction.
Discussion
The patient lived in a nursing home and was admitted with a chest infection which might have been due to aspiration. He was not able to nourish himself and was fed by the nurses and relatives. After admission to hospital he subsequently developed small bowel obstruction. Ultrasound and CT was performed to secure the diagnosis and to find the cause of obstruction. CT revealed an unclear foreign body in the small bowel, which was identified intraoperatively as a gherkin (a small cucumber). This gherkin had been swallowed by the patient as a whole and obstructed the small bowel.
Differential Diagnosis List
Mechanical small bowel obstruction caused by a swallowed gherkin
Obstruction caused by other foreign body
Adhesions
Small bowel tumor
Final Diagnosis
Mechanical small bowel obstruction caused by a swallowed gherkin
Case information
URL: https://www.eurorad.org/case/9347
DOI: 10.1594/EURORAD/CASE.9347
ISSN: 1563-4086