A Case of Duodenal Stenosis due to a Seed of Loquat

Toru Kawaoka, Gaku Fukamitsu, Yukio Ikeda, Atsushi Nagashima, Sakurao Hiraki, Shintaro Fukuda and Masaaki Oka*

Department of Surgery, Ube Industries Central Hospital
Department of Surgery II, Yamaguchi University Graduate School of Medicine*

A 80-year-old woman admitted for vomiting without bile juice after meals, anorexia, and upper abdominal distension. Plain abdominal computed tomography (CT) findings showed a high-density 1×1.5 cm foreign body inside the second portion of the duodenum. Upper gastrointestinal endoscopy showed severe duodenal stenosis, necessitating laparotomy. After an unsuccessful attempt to reduce the mass, it was removed via duodenotomy on the opposite side of the ampulla of Vater. The mass was a loquat seed, probably ingested one month earlier. The seed was impacted in the duodenum, and adhered to the duodenal mucosa. No obstruction was seen on the anal end of the duodenum. The stenosis was close to the ampulla of Vater, eliminating the need for structure-plasty. After the duodenotomy was closed, we conducted gastrojejunostomy. The patient's postoperative course was uneventful. The fact that abdominal CT clearly showed the loquat seed contributed to greatly to diagnosis, together with the patient's detailed history.

Key words
seed, duodenal obstruction, loquat

Reprint requests
Toru Kawaoka Department of Surgery, Ube Industries Central Hospital
750 Nishikiwa-ku, Ube, 755-0151 JAPAN

Accepted
May 21, 2008

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