Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 5, Number 2, February 2014, pages 98-104

Chronic Intestinal Dysmotility (CID) Secondary to Consumption of Sushi: A Case Series and Literature Review


Table 1. Overview of Chronic Intestinal Pseudo-Obstruction
EtiologyPresentation and Treatment
Modified from Stanghellinin et al.
1. Neuropathic (Gut nerve dysfunction)Presentation
  Familial: Congenital and Familial visceral neuropathies, von Recklinghausen disease  Onset - days to months
  Inflammatory: Chagas disease, Varicella, Kawasaki disease  Severe abdominal pain
  Metabolic: Diabetes Mellitus, Porphyria, Mitochondrial neuro-gastrointestinal encephalomyopathy, Endocrine and electrolyte disorders  Inability to eat
  Weight loss
  Infiltrative: Amyloidosis, Progressive systemic sclerosis,  Abdominal distension
  Neoplastic: Para-neoplastic disease  Increased bowel sounds
  Toxic: Drugs- narcotics, anti-hypertensives, anti-depressants, anti-cholinergics, laxative abuse, vincristine; heavy metals and Insecticides  Nausea and Vomiting
  Constipation ± Diarrhea
  Idiopathic: Hirschsprung disease  Megacolon
2. Myopathic (Gut muscle dysfunction)
  Familial: Familial visceral myopathiesTreatment
  Idiopathic: Non familial hollow visceral myopathy  Nutrition and hydration restoration
  Other: Myotonic and others dystrophies, Polymyositis, Dystrophia myotonica  Symptomatic Relief
3. Neuropathic and myopathic  Pro-kinetics
  Myxedema, Pheochromocytoma, Hypoparathyroidism, Pregnancy, Enteroglucagonoma, Trauma, Jejuno-ileal bypass  Anti-cholinestrase
4. Other: Radiation, Strongyloidosis, Ehler-Danlos syndrome, Mesenteric panniculitis, Ceroidosis  Suppression of bacterial overgrowth
  Surgery plays a limited role
  Role of intestinal Pacemaker


Table 2. Summary of the Clinical Features, Lab Interventions and Outcomes
SymptomsSushi intake
20/FConstipation, abdominal pain, bloating, nausea and vomiting2 months2 monthsHyperplasia consistent with chemical gastritisDiffusely dilated colonHigh fiber diet, pro-kinetic, stop sushi
16/Mconstipation, Abdominal pain, weight loss, nausea and vomiting0ne month2 monthsChronic gastritis, GERD, GastroparesisGastric emptying - 83 minutesPPI, pro-kinetic, stop sushi
26/FSevere constipation requiring manual disimpactionMore than a year10 yearsHiatal Hernia, GERD, GastritisDilated ascending colon, Poor peristalsisPPI, pro-kinetic, standard instructions for hiatal hernia, stop sushi
28/MEpigastric pain, bloating, gas, early satiety, nausea, diarrhea and weight loss2 months12 yearsRetained food in Duodenum, Chronic gastritisNo abnormalityPPI, pro-kinetic, stop sushi


Table 3. Systemic Effects due to Mercury Overexposure (Taken From Multiple Resources)
Cardiovascular systemIschemic heart disease
Nervous SystemImpairment of the peripheral vision
Dysesthesias - “pins and needles” sensations in the hands, feet and around the mouth
Lack of coordination of movements
Emotional disturbances
Impairment of speech, hearing, walking
Muscle weakness
Immune SystemImmuno-suppression
Autoimmune responses
Fetus, infants, Young childrenStill Births in Manimata city in Japan in 1950s
Impaired neurological development
Mental retardation, Cerebellar ataxia, Primitive reflexes, Dysarthria, Hyperkinesias, Autism
Impairment of cognitive thinking, memory, attention, language, fine motor and visual spatial skills


Table 4. EPA Recommendations for Fish Consumption Based on Hg Levels (Taken From Multiple Resources)
Hg LevelType of fishRecommendation
HighKing Mackerel, Tuna steaks, Sushi grade tuna, swordfish, Tile fish, Shark, Orange roughy, Marlin, Grouper, Chilean sea bassDo not eat
LowButter fish, Cat fish, Cod, Crab, Croaker (Atlantic), Flounder, Haddock, Jack smelt, Mackerel (North Atlantic), Mullet, Mussels, Perch (Ocean or White), Scallops, Shad (American), Sole, Squid, Trout (fresh water), Tuna (canned light), White fishEat up to 2 serving/week
Very low HgAnchovies, Clams, Crayfish/Crawfish, Hake, Herring, Oysters, Pollock, Sardines, Tilapia, Whiting, ShrimpEat up to 5 serving/week