Abdominal pain after consuming a chestnut

Question: A 68-year-old woman presented to our hospital with a 1-month history of abdominal pain. The pain had worsened, with bilious vomiting since the night before hospitalization. She had undergone a pyloroplasty for perforated peptic ulcer 18 years previously. The patient reported that she consumed an excessive amount of chestnuts for months, especially in recent days before hospitalization. On physical examination, her upper abdomen was mild and tender without rebound tenderness. Laboratory tests revealed leukocytosis with a white blood count of 12,080 mm3 (normal, 4000–10,000).