An unusual endoscopic finding - Acute diverticulitis / Un hallazgo endoscópico inusual - diverticulitis aguda

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Clinico-pathological and oncological differences between right and left-sided colon cancer (stages I-III): analysis of 950 cases

Purpose: The objective of the study was to analyze the clinico-pathological differences and the oncologic outcomes between right and left-sided colon cancer. Patients and methods: The patients cohort was identified from a prospective register of colon cancer, 950 patients underwent surgery (stages I, II and III), of which 431 had right-sided colon cancer and 519 had left-sided colon cancer. Results: More laparoscopic resections were performed (101 vs 191; p < 0.001) and operating times were longer (146 min vs 165 min; p < 0.001) in the left-sided colon group. Patients with right-sided colon cancer more frequently received transfusions (18.8% vs 11.3%; p < 0.001) and experienced a greater number of complications (28.5% vs 20.9%, p =0.004), although severity and operative mortality were similar in both groups (1.2% vs 0.2%). Mucinous adenocarcinomas and undifferentiated tumors were more frequent in the right-sided group (12% vs 6.5%; p < 0.001). Early stage was predominant in the left-sided colon tumors (28.2% vs 34.5%, p = 0.02). There were no differences in disease-free survival (DFS) in stages I and II after a median follow-up of 103 months. However, a greater survival at five and ten years in left-sided, stage III tumors was observed, with a trend towards statistical significance (p = 0.06). No differences were found with regard to the patterns of recurrence. Conclusions: Right-sided colon cancer exhibits phenotypical differences with regard to left-sided colon cancer. In stage III disease, left-sided colon cancer has a greater survival with a trend towards statistical significance. Overall, tumor location is a variable that should be taken into consideration in clinical studies of colon cancer (AU)

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Colitis isquémica inducida por olanzapina / Olanzapine-induced ischemic colitis

Introducción: la colitis isquémica (CI) es un efecto adverso infrecuente de los fármacos antipsicóticos que aparece de forma más común con los antipsicóticos fenotiazínicos y los antipsicóticos atípicos como la clozapina. El riesgo de desarrollar colitis isquémica se incrementa cuando se asocian fármacos con efecto anticolinérgico. Caso clínico: presentamos el caso de una mujer de 38 años con historia de trastorno esquizoafectivo, en tratamiento crónico con quetiapina desde hacía 3 años, que acudió a urgencias por cuadro de diarrea de 5 días de evolución. Cuatro meses antes se añadió olanzapina a su medicación psiquiátrica. A la exploración física presentaba distensión abdominal con timpanismo y dolor a la palpación. En la analítica de urgencias destacaba elevación de reactantes de fase aguda. La tomografía objetivó engrosamiento concéntrico de la pared de colon transverso, descendente y sigma, sin signos de perforación intestinal. La colonoscopia demostró afectación grave de la mucosa desde sigma hasta ángulo hepático con ulceraciones y exudado fibrinoide. Las biopsias confirmaron el diagnóstico de colitis isquémica. Como único antecedente relevante destacaba el nuevo fármaco añadido hacía 4 meses a su medicación de base. Se sospechó un efecto adverso debido a su acción anticolinérgica a nivel intestinal y fue retirado. A los 6 meses de seguimiento se evidenció recuperación clínica, analítica y endoscópica. Discusión: se debe tener presente la medicación antipsicótica como causa potencial de colitis isquémica, especialmente los antipsicóticos atípicos como la clozapina y la olanzapina, ya que, a pesar de ser un efecto adverso poco frecuente, puede implicar elevada morbimortalida (AU)

Ischemic colitis (IC) is an uncommon adverse event associated with antipsychotic agents, more commonly found with phenothiazine drugs and atypical neuroleptics such as clozapine. The risk of developing ischemic colitis increases when anticholinergic drugs are associated. We report the case of a 38-year-old woman with a history of schizoaffective disorder who had been on chronic quetiapine for 3 years, and presented to the ER because of diarrhea for 5 days. Four months previously, olanzapine had been added to her psychiatric drug regimen. Physical examination revealed abdominal distension with abdominal tympanic sounds and tenderness. Emergency laboratory tests were notable for increased acute phase reagents. Tomography revealed a concentric thickening of the colonic wall in the transverse, descending and sigmoid segments, with no signs of intestinal perforation. Colonoscopy demonstrated severe mucosal involvement from the sigmoid to the hepatic flexure, with ulcerations and fibrinoid exudate. Biopsies confirmed the diagnosis of ischemic colitis. The only relevant finding in her history was the newly added drug to her baseline regimen. An adverse effect was suspected because of its anticholinergic action at the intestinal level, and the drug was withdrawn. After 6 months of follow-up clinical, laboratory and endoscopic recovery was achieved. Therefore, antipsychotic medication should be considered as a potential cause of ischemic colitis, particularly atypical antipsychotics such as clozapine and olanzapine; despite being uncommon, this adverse event may result in high morbidity and mortality (AU)

Pneumoperitoneo tras TAC-colonoscopia en paciente con colitis ulcerosa / Pneumoperitoneum after CT colonography in a patient with ulcerative colitis

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Varón con dolor agudo en fosa ilíaca izquierda / No disponible

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