Small bowel obstruction caused by impacted cork foreign body mimicking the small bowel feces sign: An educational imaging case

Small bowel obstruction (SBO) caused by impacted vegetal foreign bodies is uncommon and may mimic the small bowel feces sign on computed tomography (CT), potentially leading to diagnostic delay. Differentiating these entities is important because the feces sign is a secondary imaging feature of obstruction, whereas foreign bodies represent the primary obstructing cause. We report the case of a 25-year-old man with chronic psychosis who presented with abdominal pain, vomiting, abdominal distension, and cessation of flatus and stool. Contrast-enhanced abdominal CT demonstrated dilated small bowel loops with an abrupt transition point in the distal ileum. At this level, a 27-mm well-circumscribed heterogeneous intraluminal mass containing multiple air foci was initially interpreted as the small bowel feces sign. Additional lesions with identical imaging characteristics were identified in the stomach. Retrospective review suggested impacted ingested cork material rather than a simple feces sign. This case highlights that a mottled gas-containing intraluminal mass at the transition zone should not automatically be considered the small bowel feces sign. When the lesion is discrete and associated with similar gastric material, an obstructing bezoar or vegetal foreign body should be suspected. CT plays a key role in accurate diagnosis and management planning.