Acute Nontraumatic Abdominal Pain in Adult Patients: Abdominal Radiography Compared with CT Evaluation

Abstract

Saba senegalensis (SS) is a well-known and commonly eaten fruit in Western Africa, especially in the rainy season when it is abundant. The ingestion of its seeds may cause abdominal pain and bowel obstruction. This cause might not be recognized by radiologists who are not aware of SS CT features. We thus present the characteristic CT features of SS as found in patients presenting with abdominal pain and incidentally in others. We also discuss the differential diagnosis with the cowries (ornament) and other similar fruits as imaged on CT. From 2009 through 2015 a series of 14 patients, aged 4-65 years (10 males) were referred to our hospital. The reasons for abdominal/lumbar CT were: abdominal pain only, signs of bowel occlusion, neoplasm, trauma, scoliosis and spondylodiscitis. In all these patients, we found in the bowel, objects appearing as oval-shaped foreign bodies, spontaneously hyperdense with a midline hypodense line along its long axis (Figure 1A, B). The multiplicity, same shape and density of the objects led us to search for something swallowed. In most of the cases we reached the final diagnosis of tropical fruits ingestion after questioning the relatives. Our own investigations Figure 1: Axial CT images showing (A) SS seeds, incidentally found in the bowel (arrows), and (B) A seed impacted in the ileocecal valve (arrow), responsible for occlusion; Photograph (C) and CT (D) of SS; seed (dark arrow): maximum long diameter: 16 mm, high density of the shell (256 HU) and the midline linear hypodensity (92 HU).

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