A case of pyloric obstruction due to hardened rice cake successfully treated with endoscopy

A 48-year-old woman presented with severe epigastric pain and vomiting. Blood test results were unremarkable. Computed tomography revealed a high-density material in the stomach. Emergency upper gastrointestinal endoscopy revealed two rice cakes in the stomach, one of which was impacted by the pylorus. The impaction was released using the scope, but retrieval was difficult. Therefore, they were fragmented using forceps and a high-frequency snare. Her symptoms resolved promptly after the procedure. Rice cakes are known to cause airway or intestinal obstruction due to their adhesive nature; however pyloric impaction with epigastric pain is rarely reported. Rice cakes are rich in amylopectin, which hardens at lower temperatures and resists digestion. When retained in the stomach, hardened rice cakes can cause gastric ulcers. They need to be removed promptly; however, when retrieval is difficult, fragmentation alone may facilitate passage through the stomach, which relieves symptoms.