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PICTURES IN CLINICAL MEDICINE
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Gastric Ulcer Caused by the Retention of Rice Cakes Shu Kiyotoki, Jun Nishikawa, Kunihiko Tajima and Isao Sakaida Key words: gastric ulcer, rice cakes (Intern Med 54: 241-242, 2015) (DOI: 10.2169/internalmedicine.54.2760)
Picture 1.
Picture 2.
Picture 3.
A 60-year-old man admitted to our hospital complained of abdominal pain and black stools. One month earlier, he had swallowed two pieces of boiled rice cakes without ade-
quately chewing the food due to a loss of teeth. He had no history of taking non-steroidal anti-inflammatory drugs (NSAIDs). Anti-H. pylori IgG antibodies were negative. A
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Japan Received for publication February 24, 2014; Accepted for publication May 14, 2014 Correspondence to Dr. Jun Nishikawa, [email protected]
241
Intern Med 54: 241-242, 2015
DOI: 10.2169/internalmedicine.54.2760
computed tomography examination showed two high-density objects 3 cm in diameter in the stomach, one of which appeared to be lodged in the gastric antrum (Picture 1). Urgent esophagogastroduodenoscopy (EGD) revealed two pieces of rice cakes and a deep ulcer in the antrum (Picture 2, 3). We cut the rice cakes into small pieces with a polypectomy snare, and the patient’s symptoms immediately improved. Repeat EGD showed that the rice cakes had passed from the stomach and that the ulcer was beginning to heal. Rice cakes are popular in various Asian countries. Although cases of rice cake-induced ileus have been reported in Japan (1), such a large gastric ulcer resulting from the ingestion of rice cakes has not been previously reported. It is
thought that insufficient chewing of boiled rice cakes can lead to ulcer formation following mechanical and thermal stimulation (2). The authors state that they have no Conflict of Interest (COI).
References 1. Miura T, Kimura N, Nakamura J, et al. Rice cake ileus--a rare and ethnic but important disease status in east-southern Asia. Intern Med 50: 2737-2739, 2011. 2. Fujii M, Sakashita M, Wakamura K, et al. Multiple gastric ulcers caused by a rice cake as an intragastric foreign body. J Gastroenterol 41: 282-283, 2006.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
242
PICTURES IN CLINICAL MEDICINE
□
Gastric Ulcer Caused by the Retention of Rice Cakes Shu Kiyotoki, Jun Nishikawa, Kunihiko Tajima and Isao Sakaida Key words: gastric ulcer, rice cakes (Intern Med 54: 241-242, 2015) (DOI: 10.2169/internalmedicine.54.2760)
Picture 1.
Picture 2.
Picture 3.
A 60-year-old man admitted to our hospital complained of abdominal pain and black stools. One month earlier, he had swallowed two pieces of boiled rice cakes without ade-
quately chewing the food due to a loss of teeth. He had no history of taking non-steroidal anti-inflammatory drugs (NSAIDs). Anti-H. pylori IgG antibodies were negative. A
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Japan Received for publication February 24, 2014; Accepted for publication May 14, 2014 Correspondence to Dr. Jun Nishikawa, [email protected]
241
Intern Med 54: 241-242, 2015
DOI: 10.2169/internalmedicine.54.2760
computed tomography examination showed two high-density objects 3 cm in diameter in the stomach, one of which appeared to be lodged in the gastric antrum (Picture 1). Urgent esophagogastroduodenoscopy (EGD) revealed two pieces of rice cakes and a deep ulcer in the antrum (Picture 2, 3). We cut the rice cakes into small pieces with a polypectomy snare, and the patient’s symptoms immediately improved. Repeat EGD showed that the rice cakes had passed from the stomach and that the ulcer was beginning to heal. Rice cakes are popular in various Asian countries. Although cases of rice cake-induced ileus have been reported in Japan (1), such a large gastric ulcer resulting from the ingestion of rice cakes has not been previously reported. It is
thought that insufficient chewing of boiled rice cakes can lead to ulcer formation following mechanical and thermal stimulation (2). The authors state that they have no Conflict of Interest (COI).
References 1. Miura T, Kimura N, Nakamura J, et al. Rice cake ileus--a rare and ethnic but important disease status in east-southern Asia. Intern Med 50: 2737-2739, 2011. 2. Fujii M, Sakashita M, Wakamura K, et al. Multiple gastric ulcers caused by a rice cake as an intragastric foreign body. J Gastroenterol 41: 282-283, 2006.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
242
