Mushrooms that had been handpicked were butter-roasted and eaten by six neighborhood residents. All 6 individuals subsequently developed nausea within 60 min to 90 min after the meal. They requested an ambulance and were brought to our emergency department. The ambulance service staff mentioned the possibility that the ingested mushrooms were Lampteromyces japonicus. After admittance, symptomatic conservative treatment relieved the symptoms and all 6 individuals were discharged the next day. However, one patient was rehospitalized due to complaints of abdominal pain and anorexia and another patient was rehospitalized with complaints of vomiting and bloody stool 2 days after initial discharge. In the latter patient, abdominal computed tomography revealed marked wall thickening of the duodenum and jejunum. Typically, the symptoms caused by Lampteromyces japonicus are vomiting, diarrhea, and abdominal pain within 30 min to 3 h after ingestion, but intestinal edema may occur after a few days in severe cases.

Enterovesical fistula is a relatively uncommon complication of colorectal and pelvic malignancies, diverticulitis, inflammatory bowel disease, radiotherapy, and trauma in Asian countries. A case of vesico-ileosigmoidal fistula and a literature review of this disease in Japan are presented. A 70-yr-old male was referred with complaints of urinary pain and pneumaturia. On admission, urinary tract infection and pneumaturia were presented. A barium enema demonstrated multiple diverticulum in his sigmoid colon and the passage of contrast medium into the bladder and ileum. Under the diagnosis of vesico-ileosigmoidal fistula due to suspected diverticulitis of the sigmoid colon, sigmoidectomy and partial resection of the ileum with partial cystectomy were performed. The histopathology revealed diverticulosis of the sigmoid colon with diverticulitis and development of a vesico-ileosigmoidal fistula. No malignant findings were observed. Until the year 2000, a total of 173 cases of vesico-sigmoidal fistula caused by diverticulitis had been reported in Japan. Pneumaturia and fecaluria are the most common types, presenting symptoms in 63% of the cases. Computed tomography, with a sensitivity of 40% to 100%, is the most commonly used diagnostic study. For patients with vesico-sigmoidal fistula, resection of the diseased sigmoid colon and partial cystectomy with primary anastomosis are the safest and most acceptable procedures, leading to the best results.
Aged ; Anastomosis, Surgical ; Bladder Fistula/*etiology/*pathology/surgery ; Colon, Sigmoid/pathology ; Cystectomy ; Diverticulitis/*complications/*pathology/surgery ; Human ; Ileum/pathology ; Male

Scrotal hematocele is defined as retention of blood in the tunica vaginalis. Although it is usually an acute change, it can also have a chronic course. A 55-year-old man was being treated for hypertension and diabetes in the Department of Internal Medicine at our hospital. He visited the hospital’s Department of Urology because 3 months earlier he had noticed enlargement of the right scrotum without trauma to the perineum. The right scrotum was swollen to the size of a small child’s head. Imaging examination showed no testicular tumor. Puncture yielded 550 ml of bloody fluid. Surgery was performed to find and treat the source of bleeding. The tunica vaginalis was highly irregular and thickened. Considering the possibility of mesothelioma or other malignancy, we removed the testis after transection of the spermatic cord as proximally as possible. The histopathological diagnosis was encapsulated hematoma with cholesterin granuloma, which was diagnosed as chronic scrotal hematocele.

Edwardsiella tarda causes enterocolitis, which does not need to be treated in many cases. However, in immunocompromised hosts, the disease becomes severe resulting in soft tissue abscess. In such cases, removal of the lesion is required at an early stage. An 83-year-old woman presented to the emergency department with a chief complaint of fever, which was initially treatment as complex urinary tract infection. Further evaluation revealed she had E. tarda sepsis and that the bacteria was highly likely to originate from an abscess of the uterine adnexa. Because we thought a complex surgery was necessary, we transferred her to a regional core hospital. However, she recovered with only administration of antibacterial agents at that hospital.Then, 1 year and 4 months later, she was admitted to our hospital again. We made a diagnosis of disease recurrence. She did not improve with antibacterial therapy this time, so she was transferred to the other regional core hospital and underwent surgery. Histological examination revealed an appendiceal carcinoma in the abscess lesion. This case suggests that when E. tarda bacteremia is diagnosed, its focus and the root cause should be investigated.