J Med Cases

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

Journal website http://www.journalmc.org

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
Etiology	Presentation 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 myopathies	Treatment
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 Laxatives
4. Other: Radiation, Strongyloidosis, Ehler-Danlos syndrome, Mesenteric panniculitis, Ceroidosis	Suppression of bacterial overgrowth Surgery plays a limited role Role of intestinal Pacemaker

Table 1. Overview of Chronic Intestinal Pseudo-Obstruction

Etiology

Presentation 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 myopathies

Treatment

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
Laxatives

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
Age/sex	Presentation	Duration	Endoscopy/Pathology	Colonoscopy/Other	Treatment
20/F	Constipation, abdominal pain, bloating, nausea and vomiting	2 months	2 months	Hyperplasia consistent with chemical gastritis	Diffusely dilated colon	High fiber diet, pro-kinetic, stop sushi
16/M	constipation, Abdominal pain, weight loss, nausea and vomiting	0ne month	2 months	Chronic gastritis, GERD, Gastroparesis	Gastric emptying - 83 minutes	PPI, pro-kinetic, stop sushi
26/F	Severe constipation requiring manual disimpaction	More than a year	10 years	Hiatal Hernia, GERD, Gastritis	Dilated ascending colon, Poor peristalsis	PPI, pro-kinetic, standard instructions for hiatal hernia, stop sushi
28/M	Epigastric pain, bloating, gas, early satiety, nausea, diarrhea and weight loss	2 months	12 years	Retained food in Duodenum, Chronic gastritis	No abnormality	PPI, pro-kinetic, stop sushi

Table 2. Summary of the Clinical Features, Lab Interventions and Outcomes

Age/sex

Presentation

Duration

Endoscopy/Pathology

Colonoscopy/Other

Treatment

Symptoms

Sushi intake

20/F

Constipation, abdominal pain, bloating, nausea and vomiting

2 months

Hyperplasia consistent with chemical gastritis

Diffusely dilated colon

High fiber diet, pro-kinetic, stop sushi

16/M

constipation, Abdominal pain, weight loss, nausea and vomiting

0ne month

2 months

Chronic gastritis, GERD, Gastroparesis

Gastric emptying - 83 minutes

PPI, pro-kinetic, stop sushi

26/F

Severe constipation requiring manual disimpaction

More than a year

10 years

Hiatal Hernia, GERD, Gastritis

Dilated ascending colon, Poor peristalsis

PPI, pro-kinetic, standard instructions for hiatal hernia, stop sushi

28/M

Epigastric pain, bloating, gas, early satiety, nausea, diarrhea and weight loss

2 months

12 years

Retained food in Duodenum, Chronic gastritis

No abnormality

PPI, pro-kinetic, stop sushi

**Table 3.** Systemic Effects due to Mercury Overexposure (Taken From Multiple Resources)
Cardiovascular system	Ischemic heart disease Hypertension
Nervous System	Impairment 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 System	Immuno-suppression Autoimmune responses
Fetus, infants, Young children	Still 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 3. Systemic Effects due to Mercury Overexposure (Taken From Multiple Resources)

Cardiovascular system

Ischemic heart disease
Hypertension

Nervous System

Impairment 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 System

Immuno-suppression
Autoimmune responses

Fetus, infants, Young children

Still 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 Level	Type of fish	Recommendation
High	King Mackerel, Tuna steaks, Sushi grade tuna, swordfish, Tile fish, Shark, Orange roughy, Marlin, Grouper, Chilean sea bass	Do not eat
Low	Butter 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 fish	Eat up to 2 serving/week
Very low Hg	Anchovies, Clams, Crayfish/Crawfish, Hake, Herring, Oysters, Pollock, Sardines, Tilapia, Whiting, Shrimp	Eat up to 5 serving/week

Table 4. EPA Recommendations for Fish Consumption Based on Hg Levels (Taken From Multiple Resources)

Hg Level

Type of fish

Recommendation

High

King Mackerel, Tuna steaks, Sushi grade tuna, swordfish, Tile fish, Shark, Orange roughy, Marlin, Grouper, Chilean sea bass

Do not eat

Low

Butter 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 fish

Eat up to 2 serving/week

Very low Hg

Anchovies, Clams, Crayfish/Crawfish, Hake, Herring, Oysters, Pollock, Sardines, Tilapia, Whiting, Shrimp

Eat up to 5 serving/week