Small bowel perforation subsequent to mushroom bezoar as a presentation of Crohn's disease

• Published in: The American surgeon 2013-08, Vol.79 (8), p.E278-280
• Main Authors: Nabeel-Zafar, Syed, Traverso, Purnell, Asare, Mariette, Romero, Nahir, Changoor, Navin R, Hughes, Kakra, Greene, Wendy R
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Agaricales; Bezoars - complications; Bezoars - diagnosis; Crohn Disease - complications; Crohn Disease - diagnosis; Food; Humans; Inflammatory bowel disease; Intestinal Perforation - diagnosis; Intestinal Perforation - etiology; Jejunal Diseases - diagnosis; Jejunal Diseases - etiology; Jejunum; Male; Mushrooms; Pain
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481307900810

The current thinking is that foods with a high concentration of cellulose polymerize in the stomach to form adhesive protein complexes, which may lodge in some part of the intestine. 1 Predisposing factors are thought to include a high-fiber diet, improper chewing (as a result of inadequate dentation or mentation), gastric hyposecretion, hypomotility, previous gastric surgery, and intestinal strictures.2 Mushrooms are a rare cause of phytobezoar and have been reported only six times in the literature.2, 3 Mushrooms contain a large proportion of nitrogenous carbohydrates comparable to that of chitin. [...]although it is rare, obstruction leading to perforation in a patient with Crohn's disease can be caused from undigested food substances, the pathophysiology of which is thought to involve an unfortunate combination of mass, stricture, and friable bowel wall.