Ileal Ulcer Associated With a Large Bezoar Mimicking Malignancy on FDG PET/CT

Trichobezoar presenting as an acute abdominal obstruction in a 17-year-old girl

Trichobezoars are hairballs that combine with food residue in the digestive tract as a result of ingesting hair. A 17-year-old girl was admitted to the emergency department with abdominal pain and vomiting for 3 days. She had been having digestive difficulty and bloating for the previous 2 months. An abdominal radiograph demonstrated air-fluid levels consistent with ileus, and an ultrasound showed hyperechoic material in the stomach and ileum. Computed tomography demonstrated images of trapped air which was considered diagnostic of a bezoar. At laparotomy, a large mass was removed from the stomach. As the bezoar extended through the pylorus and duodenum and there were mobile masses palpable in the ileum, it required a second incision to remove them. For some years she had had a habit of swallowing hair which she found on her pillow and there was a history of an obsessive personality trait and hyperactivity for which she agreed to attend a psychiatric clinic.Abbreviations: BMI: body mass index; CT: computed tomography; Hb: haemoglobin; IV: intravenous; WHO: World Health Organization.

FDG PET/CT in Cryptogenic Multifocal Ulcerating Stenosing Enteropathy

ABSTRACT

Cryptogenic multifocal ulcerating stenosing enteropathy (CMUSE) is a rare and exclusive small intestine disease, characterized by repeated anemia or obstruction resulting from multiple shallow ulcers with strictures in the small intestine. We present a case of CMUSE showing multiple foci of activity in the small bowel on FDG PET/CT. This case indicates that CMUSE should be included in the differential diagnosis of multifocal FDG activity in the small bowel along with lymphoma, carcinoma, tuberculosis, Crohn disease, Behçet disease, and drug-induced enteropathy.