We report a case of acute renal failure after extraluminal injection of glycerin enema and discuss the side effects of glycerin enema. A woman in her sixties with anal prolapse complained of anal pain after bowel preparation for colonoscopy with administration of 120mL of 50% glycerin enema. She complained of epigastralgia and nausea 2 h after the enema. Brown urine was observed 10 h after the enema, and urine volume was 96mL/day by the next day. Laboratory data revealed evidence of hemolysis and renal dysfunction, and computed tomography showed air and edema around the rectum. Based on these findings, we made a diagnosis of acute renal failure caused by extraluminal injection of glycerin enema. Hemodialysis was performed 6 times over the course of 9 days, and haptoglobin was administered to prevent renal damage from hemolysis. Following this treatment, there was recovery of renal function and this normalized 2 months after the enema.

　　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.

　Purpose: Although a late-evening snack (LES) has been recommended to patients with chronic liver disease, the effects of long-term carbohydrate-enriched LES still remain debatable. The purpose of this study was to clarify the usefulness of the LES in outpatients with liver cirrhosis.　　Materials and Methods: A nutritional education using LES was given once every month during six months by registered dietitians and pharmacists to 23 outpatients with liver cirrhosis. Seventeen patients were graded A in light of Child classification, and six were graded B. The LES consisted of health foods such as rice balls and bread with 100-200 kcal carbohydrate. Serum AST, ALT, total bilirubin, total protein and albumin levels were evaluated before the nutritional education and 12 months after the start of the education.　　Results: The nutritional education was finished by 19 patients (82.9%). No significant differences were observed in AST, ALT, total bilirubin and total protein values between before and after the education. In 14 patients who were graded Child A and B after the education, with the exception of two patients graded Child C after the education, serum albumin concentrations after the education were significantly higher than those before the education.　　Conclusions: The long-term nutritional therapy with carbohydrate-enriched LES can be performed in the most efficient way on a large percentage of outpatients with liver cirrhosis. This nutritional therapy may be useful for liver cirrhosis patients so long as the liver functions fairly well.

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.

A man in his 40s visited our hospital with a chief complaint of upper abdominal pain after defecation. His general and local conditions were good. Intraperitoneal free air was detected on an abdominal computed tomography (CT) scan, and laboratory tests revealed leukocytosis. Esophagogastroduodenoscopy showed no abnormalities. Emergent laparotomy was performed because of the suspected intestinal perforation, but neither perforation nor peritonitis was observed. Bacterial culture of intraperitoneal lavage fluid was negative. The postoperative course was uneventful and he was discharged. Because the cause of pneumoperitoneum was unknown, the diagnosis was idiopathic pneumoperitoneum. However, we had the opportunity to evaluate abdominal CT images taken with the lung window setting 4 years before the operation, which showed pneumatosis intestinalis in the ileocecal region. It has been reported that metachronous pneumatosis intestinalis is sometimes detected in cases of pneumoperitoneum with pneumatosis intestinalis. Thus, pneumatosis intestinalis was suspected as the cause of pneumoperitoneum in this case.