Blind Dates - Potential Killers: Jujube Kernel Caused Enterobrosis Need to be Differentiated with Acute Appendicitis – A Chinese Single Center Case Series Study

Abstract

Background: Accidentally swallowed date kernels are high risk factors for enterobrosis. Most patients showed no obvious symptoms at the beginning but later developed lower abdominal pain, which should be differentiated with acute appendicitis, especially in elder patients without a clear medical history. This study investigated the clinical features, diagnosis and treatment of enterobrosis caused by accidentally swallowed kernel of Chinese date in adults. Methods: A retrospective analysis was performed on 14 cases of adult patients suffered from date kernel - induced enterobrosis during June 2016 to June 2019. All these patients received treatment in the first hospital of China medical university. Results: Eleven female and three male patients were diagnosed, and they were mainly in the middle to elderly age, with 12/14 patients (86%) above 50 years old. The main clinical manifestations were abdominal pain, with onset times from seven hours to four days, and all patients visited the emergency department. Physical signs of local or diffuse peritonitis were presented as guarding tenderness, rebounding, and increased rigidity. Through full-abdominal enhanced CT examination, high density linear objects were identified at the terminal or distal ileum segments in 11/14 (78%) patients. During emergent laparotomy, enterobrosis were found in all patients. Secondary perforations were also detected in 6/14 (42%) patients on the opposing side of the first puncturing sites. The fusiform kernels with two sharp tips were extracted by minimal enterotomies in 13 patients. In one patient with colonic perforation, sigmoid colostomy was performed. All patients were cured and 93% of them were discharged within two weeks. Conclusions: Full-abdominal enhanced CT examination is of great diagnostic value for the intestinal perforation caused by date kernels, and patients can benefit from early surgical treatment after definite diagnosis. Thorough exploration should be performed to detect whether a second perforation was formed on the contrary site of first piercing site. Caution should be taken to void “blind dates” ingestion, and special tools such as seeders and slicers are recommended to removal kernels in advance, thus prevent the potential killing threats of enterobrosis.