LAUSR

MOST INGESTED FOREIGN bodies (80–90%) pass spontaneously through the gastrointestinal tract. Approximately 10–20% of cases of foreign body ingestion require endoscopic removal, while in <1% cases, surgery is required. The patient was a 65-year-old Japanese man who presented with a 2-day history of abdominal pain and distension. He had no history of previous surgery. Abdominal computed tomography (CT) revealed marked dilatation of the stomach and a small intestinal obstruction with a mass-like structure and evenly distributed air bubbles in the obstructed area (Fig. 1a). The patient had eaten savory egg custard containing shiitake mushrooms 4 days before admission. On the fourth day postadmission, he underwent single-balloon enteroscopy (SBE), which revealed a large piece of shiitake mushroom that impacted the proximal jejunum (Fig. 1b,c). Although most parts of the shiitake mushroom were relatively easy to tear off, the shaft in particular was hard and unlikely to break down. Therefore, we placed a clip at the shaft of the shiitake mushroom for marking and attempted to carefully crush and cut away the shiitake mushroom using a clip with a dental floss, snare, and grasping forceps, although it was difficult (Fig. 2a–d). Subsequently, we attempted to capture the shiitake mushroom near the shaft with a clip, snare, and a collection net (Fig. 2e,f). Eventually, we captured the mushroom shaft with a snare and retrieved it orally. SBE revealed erosions and ulcers on the side of the oral small intestine along the Kerckring’s fold, suggesting compression or ischemic changes associated with hyperperistalsis caused by the mushroom (Fig. 2g,h). One week later, CT showed no abnormal features in the digestive tract, and the patient was discharged without complications (Video S1). Therefore, we could successfully avoid surgery in this case, as treatment with SBE was effective. Authors declare no conflict of interest for this article.