Rotura aórtica masiva secundaria a espondilodiscitis por Staphylococcus aureus / Massive aortic rupture secondary to Staphylococcus aureus spondylodiscitis

Introducción: presentamos un caso inusual de rotura aórtica múltiple secundaria a espondilodiscitis por Staphylococcus aureus sensible a meticilina. Caso clínico: varón de 71 años que ingresa en nuestro hospital para el estudio programado de una espondilodiscitis T7-T8 refractaria a tratamiento empírico antibiótico. El decimoquinto día de su ingreso el paciente presenta una hematemesis masiva con dos paradas cardiorrespiratorias. Tras ser reanimado en dos ocasiones, se realiza una endoscopia en el quirófano que sugiere la presencia de una fístula aortoentérica primaria. A su vez, en una tomografía computarizada de seguimiento se evidencia sangrado activo en la aorta torácica. Realizamos una angiografía diagnóstica en la que apreciamos tres puntos de ruptura aórtica. Se precisa la implantación de endoprótesis cubiertas para el control del sangrado: un dispositivo en la aorta torácica (Gore C-TAG®) y otro a nivel abdominal (Aortic Begraft®). Discusión: la aortitis es una complicación poco común de la espondilodiscitis con una tasa alta de mortalidad. Un alto índice de sospecha es clave para su temprano diagnóstico y tratamiento. La antibioterapia es obligatoria y el tratamiento endovascular puede usarse como terapia puente en emergencias. Es un procedimiento rápido que permite la estabilización hemodinámica del paciente antes de una cirugía abierta aórtica definitiva.(AU)

Introduction: we present an unusual case with multiple aortic ruptures secondary to methicillin-sensitive Staphylococcus aureus thoracic spondylodiscitis. Case report: the patient was a 71-year-old man admitted to our hospital for scheduled study of an infectious spondylodiscitis D7-D8 refractory to empirical antibiotic therapy. Fifteen days after admission, the patient began with massive hematemesis. After being resuscitated from two cardiac arrests, an endoscopy was carried out in the operating room suggesting presence of a primary aortoenteric fistula and, at the same time, in a follow-up computed tomography an active bleeding in thoracic aorta was shown. We performed a diagnostic angiography; three different sites of rupture were observed and two covered endogfrats were placed for bleeding control of thoracic and abdominal aorta: one device in thoracic aorta (Gore C-TAG®) and another one in abdominal aorta (Aortic Begraft®). Discussion: aortitis is an uncommon complication of spondylodiscitis, with a high mortality rate. A high index of suspicion is key to its diagnosis and prompt treatment. Antibiotherapy is mandatory and endovascular treatment can be used as a bridge therapy in emergency, it is a fast procedure that can secure hemodynamical stabilization prior to definitive aortic open repair.(AU)

Nutritórax: una complicación infrecuente de la nutrición parenteral / Nutrithorax: an uncommon complication of parenteral nutrition

INTRODUCCIÓN: la nutrición parenteral (NP) es una modalidad de soporte nutricional con posibles complicaciones, en parte asociadas al catéter venoso central (CVC). El quilotórax consiste en el derrame de líquido linfático de origen intestinal en el espacio pleural. CASO CLÍNICO: varón de 57 años ingresado para colecistectomía. Presenta un postoperatorio complicado que requiere reposo digestivo y NP. Posteriormente presenta disnea y dolor torácico con derrame pleural bilateral y pericárdico. Inicialmente se interpretó como un quilotórax, por su aspecto lechoso y su contenido en triglicéridos. La TC confirmó la malposición del CVC con salida de NP a nivel del tronco venoso innominado. Fue intervenido quirúrgicamente, realizándose un lavado del mediastino anterior y la reparación de la perforación. La evolución posterior fue favorable. DISCUSIÓN: la extravasación de la NP al espacio pleural es una complicación infrecuente pero posible de la administración de NP por vía central. Por tanto, debe tenerse en cuenta en el diagnóstico diferencial

INTRODUCTION: parenteral nutrition (PN) is commonly used as a nutritional support option. It may cause complications, partly due to a central venous access. Chylothorax is an accumulation of lymphatic fluid in the pleural space. CASE REPORT: a 57-year-old man was admitted for cholecystectomy. A complicated postoperative period required PN. Cardiorespiratory symptoms started while receiving PN, and a bilateral pleural and pericardial effusion was identified. It was initially interpreted as chylothorax due to its milky appearance and high triglyceride content. A CT scan confirmed a malposition of the CVC with PN leakage at the level of the innominate venous trunk. It was surgically repaired. DISCUSSION: parenteral nutrition leakage is an unusual complication of PN. It should be included in the differential diagnosis of pleural effusion

Hemorragia digestiva grave secundaria a esofagitis por virus del herpes simple y citomegalovirus / Severe gastrointestinal bleeding due to synchronous herpes simplex virus and cytomegalovirus esophagitis

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Sangrado digestivo por una lesión de Dieulafoy: a propósito de un caso en un hombre nonagenario y revisión de la literatura / Bleeding from Dieulafoy's lesion: a case report on a nonagenarian man and a review of the literature

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Esófago negro ¿es tan malo como parece? / Black esophagus, is it as bad as it seems?

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Perforación gástrica por palillo / Gastric perforation caused by a stick

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Hepatic angiosarcoma in a patient with liver cirrhosis / Angiosarcoma hepático en un paciente con cirrosis hepática

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Severe upper gastrointestinal bleeding due to eosinophilic gastritis / Hemorragia digestiva alta severa por gastritis eosinofilica

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Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series

Background: upper gastrointestinal bleeding (UGIB) is one of the main causes of hospital admission in gastroenterology departments and is associated with a significant morbidity and mortality. Rebleeding after initial endoscopic therapy occurs in 10-20% of cases and therefore, there is a need to define predictive factors for rebleeding. Aim: the aim of our study was to analyze risk factors and outcomes in a population of patients who suffered a rebleed. Methods: five hundred and seven patients with gastrointestinal bleeding were included. Clinical and biochemical data, as well as procedures and outcome six months after admission, were all collected. Documented clinical outcome included in-hospital and six-month delayed mortality, rebleeding and six-month delayed hemorrhagic and cardiovascular events. Results: according to a logistic regression analysis, high creatinine levels were independent risk factors for rebleeding of non-variceal and variceal UGIB. In non-variceal UGIB, tachycardia was an independent risk factor, whereas albumin levels were an independent protective factor. Rebleeding was associated with in-hospital mortality (29.5% vs 5.5%; p < 0.0001). In contrast, rebleeding was not related to six-month delayed mortality or delayed cardiovascular and hemorrhagic events. Conclusions: tachycardia and high creatinine and albumin levels were independent factors associated with rebleeding, suggestive of a potential predictive role of these parameters. The incorporation of these variables into predictive scores may provide improved results for patients with UGIB. Further validation in prospective studies is required

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Sedación paliativa en hemorragia digestiva alta masiva (hematemesis) / Palliative sedation in massive upper gastrointestinal bleeding (haematemesis)

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Gastroenteritis eosinofílica en un lactante, manifestada por una hematemesis grave / Eosinophilic gastroenteritis in an infant revealed by a severe upper digestive bleeding

La gastroenteritis eosinofílica representa una patología emergente y pertenece a un espectro reconocido de enfermedades digestivas eosinofílicas. Puede aparecer a cualquier edad y con sintomatología diversa. Su diagnóstico positivo es histológico, aunque no hay una definición precisa. Presentamos un caso atípico de un lactante de 2 meses de edad con una gastroenteritis eosinofílica manifestada por una hemorragia digestiva grave

Eosinophilic gastroenteritis is an emergent disease and belongs to a group of eosinfilic digestive illness. It is characterized by various unspecific symptoms. Histological study confirms the diagnostic even if there is not until now a clear definition about histological criteria. We present an infant of 2 months with eosinophilic gastroenteritis revealed by a severe digestive bleeding

Carcinoma verrucoso esofágico: una rara entidad de difícil diagnóstico / Verrucous carcinoma of the esophagus: A rare entity with a difficult diagnosis

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Hematemesis como debut de gastroenteritis eosinofílica en lactantes / Hematemesis as debut of eosinophilic gastroenteritis in infants

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Dysphagia and hematemesis caused by an intramural esophageal dissection

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Hemorragia digestiva recurrente por lesión de Dieulafoy tratada con éxito mediante esclerosis guiada por ecoendoscopia / Recurrent gastrointestinal bleeding secondary to Dieulafoy's lesion successfully treated with endoscopic ultrasound-guided sclerosis

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Pseudoaneurisma no traumático de la arteria cística como causa de hemobilia / Non traumatic pseudoaneurysm of the cystic artery as a cause of haemobilia

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