A case of ileus caused by a Japanese persimmon seed *
Ileus caused by digested food is very rare and accounts for only 4% of all mechanical bowel obstructions. The seeds that pass through the pylorus usually pass through the rest of the small bowel without difficulty because swallowed seeds are often small and ovoid shaped. However, we reported a case of ileus due to a Japanese persimmon seed. An 80 year old female complained of vomiting. She had undergone a hysterectomy and radiation therapy for uterine sarcoma some 40 years previously. Possible Ileus was suspected based on her clinical history and presenting symptoms. An ultrasonography revealed dilated loops of small bowel and a foreign body inside the small bowel. Specifically, the foreign body showed ovoid interface echo with smooth surface and posterior acoustic shadow. Computed tomography（CT）showed dilated loops of small bowel and a foreign body as well. Hence, ultrasonography and CT findings indicated a diagnosis of intestinal obstruction caused by a seed. The ileus tube was inserted and the bowel gas was decompressed successfully. The next day, however, after resuming her food intake, she complained of abdominal pain and vomited again. Another ultrasonography and CT showed that the seed was still situated in the small bowel. We considered the difficulties of attempting to remove the seed again, after which, we reached the alternative decision to perform an operation. The small bowel revealed elastic and mild stenosis in some lesion which was probably induced by radiation. The foreign body was found to be that of a Japanese persimmon seed. The patient’s postoperative course was without further issues. US was considered to be an effective tool and appropriate for the treatment of ileus caused by a seed. (Accepted on August 29, 2012)
