We report two cases of dietetic ileus caused by Japanese rice cake intake and review 28 cases in the Japanese literature from 1982 to 2003. Case 1: A 68-year-old man presenting at the emergency room with vomiting and severe upper abdominal pain was found in abdominal CT to have expanded small intestines with an ileus shadow and a high-density lesion, suggesting strangulated obstruction of the small intestines necessitating emergency surgery. The offending rice cake was found and removed. Case 2: A 65-year-old woman with the same complaint as in case 1 was diagnosed by CT. The intestine was incised and the rice cakes removed. Dietetic ileus caused by rice cake ingestion is easily diagnosed by CT by physicians experiencing the need for treating it. The choice of emergency surgery should be dictated by the severity of abdominal pain, with the timing of the decision to operate of paramount importance.

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Obturator hernia (OH) is a rare cause of bowel obstruction. Although several surgical approaches, including the laparoscopic approach, have been reported to date, a standard approach for treating OH has not been established. A 101-year-old woman who presented with constipation and vomiting was admitted to our hospital. CT revealed an incarcerated small bowel within the left obturator foramen, and a diagnosis of left-sided incarcerated OH with small bowel ileus was made. With the patient under general anesthesia, exploratory laparoscopy was performed; we identified an OH with an incarcerated small bowel, which was judged viable after hernia reduction. We repaired the hernia using an anterior preperitoneal approach under laparoscopic assistance and placed a prosthetic mesh over the obturator foramen. The patient recovered with no postoperative complications and was discharged on postoperative day 4. A hybrid laparoscopic and anterior preperitoneal approach is safe and effective for treating an incarcerated OH in an elderly patient.

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