A case series of intestinal obstruction secondary to shiitake mushroom intake during Chinese New Year

Abstract

Shiitake mushroom is a common ingredient in East Asian cuisines. Food processing/preparation can cause the mushroom to be soft and slimy, leading to accidental swallowing. Due to its high insoluble fibre content, it remains the same size and shape in the intestinal tract. We present two cases of small bowel obstruction caused by shiitake mushroom requiring surgical intervention. Preoperative imaging showed dilated small bowel with a suspicious mass in the ileum. However, the exact cause was unclear. For both cases, exploratory laparotomy and enterotomy were then performed and undigested shiitake mushroom was found. Both patients recovered well from the surgery.

Small Bowel Obstruction Caused by a Shiitake Mushroom: A Case Report

“…Obstruction of the small bowel loop is most commonly caused by adhesions secondary to previous intraabdominal surgery or hernia [1]. Small bowel obstruction due to bezoar impaction is considerably less common, with a reported frequency of about 4% [1][2][3]. The word bezoar comes from the Arabic word "bazahr", which means the hardened gastric contents of the Syrian goat [1,2].…”

“…Small bowel obstruction due to bezoar impaction is considerably less common, with a reported frequency of about 4% [1][2][3]. The word bezoar comes from the Arabic word "bazahr", which means the hardened gastric contents of the Syrian goat [1,2]. According to the composition of the content, bezoars are classified into 5 types: lactobezoar formed by milk curd and unique to neonates, trichobezoar caused by hairball and found in children and young adults, phytobezoar formed by vegetable and fruit and typically seen in the elderly and postgastrectomy patients, pharmacobezoar caused by medications, and lithobezoar due to sand, stone, etc [1,2,4].…”

“…The clinical presentations are nonspecific, and the diagnosis is rarely made preoperatively [2,4]. The predisposing factors for bezoar formation are prior gastric surgery, poor mastication, ingestion of high-fiber food such as persimmon, vegetarian diet, decreased gastric secretion and motility, diabetic neuropathy and hypothyroidism [1,2,4].…”

“…Small bowel obstruction is a common acute presentation in the emergency department. Small bowel obstruction secondary to bezoar impaction is much less common, with a reported frequency of around 4%, and is rarely diagnosed preoperatively [1][2][3]. Phytobezoar is a type of bezoar comprising an aggregate of indigestible vegetables or fibers in the gastrointestinal tract [1,2,4,5].…”

“…Small bowel obstruction secondary to bezoar impaction is much less common, with a reported frequency of around 4%, and is rarely diagnosed preoperatively [1][2][3]. Phytobezoar is a type of bezoar comprising an aggregate of indigestible vegetables or fibers in the gastrointestinal tract [1,2,4,5]. Shiitake mushroom is full of insoluble dietary fiber, uneasy to ingest in an uncut form, soft and slimy and can lead to accidental swallowing, especially in an aged person without teeth [6][7][8].…”