A case of colonic fecal impaction caused by excessive dietary fiber intake that was endoscopically treated with intra-fecal injection of a bowel-cleansing agent.

Background and Aim: A 75-year-old man who had eaten half a head of chopped raw cabbage (approximately 600 g) daily was suffering from the left lower pain, abdominal fullness, and constipation. He was diagnosed with colonic ileus and obstructive colitis due to a fecal impaction in the sigmoid-descending junction. During colonoscopy, a tapered catheter was repeatedly inserted into the impacted feces to inject a bowel-cleansing agent. Finally, the feces were broken to be fragmented enough to path the endoscope through. After the procedure, his symptoms were immediately relieved. Relevance for Patients: Excessive dietary fiber intake can induce fecal ileus. Endoscopic treatment with intra-fecal injection of a bowel-cleansing agent is useful and worth attempting for disimpaction of feces.

Palliative Radiotherapy for Bleeding from Unresectable Gastric Cancer Using Three-Dimensional Conformal Technique.

Optimal regimens using recent radiotherapy (RT) equipment for bleeding gastric cancer (GC) have not been fully investigated yet. We retrospectively reviewed the clinical data of 20 patients who received RT for bleeding GC in our institution between 2016 and 2021. Three-dimensional conformal RT was performed. The effectiveness of RT was evaluated by the mean serum hemoglobin (Hb) level and the number of transfused red blood cell (RBC) units 1 month before and after RT. The median first radiation dose was a BED of 39.9 Gy. The treatment success rate was 95% and the rebleeding rate was 10.5%. There was a significant increase in the mean Hb level (8.0 ± 1.1 vs. 9.8 ± 1.3 g/dL, p = 0.01), and a significant decrease in the mean number of transfused RBC units (6.8 ± 3.3 vs. 0.6 ± 1.5 units, p < 0.01). Severe toxicity was observed in two patients (anorexia [n = 1] and gastrointestinal [GI] perforation [n = 1]). Reirradiation was attempted in three patients (for hemostasis [n = 2] and for mass reduction [n = 1]). The retreatment success rate for rebleeding was 100%. GI perforation occurred in two patients who had received hemostatic reirradiation. Palliative RT for bleeding GC using recent technology had excellent efficacy. However, it may be associated with a risk of GI perforation.