[Crohn's disease and pregnancy. A descriptive and retrospective study]. / Enfermedad de Crohn y embarazo: un estudio descriptivo y retrospectivo.

OBJECTIVES: To determine the behavior of Crohn's disease during pregnancy, as well as the influence of this disease on the presence of low birthweight neonates. MATERIAL AND METHODS: A descriptive and retrospective study of all patients with Crohn's disease followed-up in the Hospital Costa del Sol was performed. A total of 124 pregnant women were included, classified in two groups: women who became pregnant before and those who became pregnant after Crohn's disease was diagnosed. In all patients, clinical and epidemiological data, disease activity during pregnancy and in the immediate postpartum period, type of assisted delivery, and neonatal birthweight were recorded. RESULTS: A total of 66.1% of pregnancies occurred before Crohn's disease was diagnosed, 31.5% occurred after diagnosis and 2.4% coincided with disease onset. No significant differences were found between women with and without a diagnosis of Crohn's disease in type of assisted delivery or low birthweight (p = 0.064; p = 0.643). All non-smoking patients remained in the quiescent phase and did not present disease recurrences during pregnancy. Among smokers, the disease remained inactive in 61.1%, while chronic activity or recurrences were observed in 38.9% (p = 0.003). CONCLUSIONS: The course of inflammatory bowel disease does not adversely affect pregnancy or the immediate postpartum period, nor does it increase the presence of low birthweight neonates or the number of cesarean deliveries performed.

[Active lower gastrointestinal bleeding due to appendiceal ulcer]. / Hemorragia digestiva baja grave activa por úlcera apendicular.

We present a case of severe lower gastrointestinal bleeding due to appendiceal ulcer associated with intake of enteric coated aspirin. Urgent colonoscopy revealed the location and characteristics of the source of bleeding during the acute episode, allowing effective treatment through simple appendicectomy to be performed.

[Pulmonary sarcoidosis associated with pegylated interferon in the treatment of chronic hepatitis C]. / Sarcoidosis pulmonar asociada a interferón pegilado en el tratamiento de la hepatitis C crónica.

Treatment with pegylated interferon is usually used in active chronic hepatitis C in association with ribavirin. The adverse effects of interferon include influenza-like syndrome and mild respiratory manifestations, which are highly frequent. Among the immunomodulatory effects is the possibility of inducing or exacerbating autoimmune phenomena such as cutaneous or systemic sarcoidosis. We present a new case of pulmonary sarcoidosis induced by pegylated interferon in a 35 year-old woman with chronic hepatitis C who developed respiratory symptoms 4 months after starting therapy with pegylated interferon associated with ribavirin. Radiological images showed a micronodular pattern in both pulmonary fields together with hilar and mediastinal adenopathies. Transbronchial biopsy confirmed the presence of sarcoidal granulomas. After the diagnosis of pulmonary sarcoidosis, antiviral therapy was suspended with subsequent resolution of the clinical symptoms.

[Ileo-ileal and ileocecal invagination due to intestinal lipomatosis]. / Invaginación ileoileal e ileocecal por lipomatosis intestinal.

Intestinal lipomatosis is a rare entity and few cases have been reported in the literature. The condition is usually asymptomatic. Symptomatic cases usually present as obstruction or, less frequently, as bleeding. Intestinal barium studies, ultrasonography and computed tomography are useful diagnostic techniques. We present the case of a 47-year-old man with no relevant medical history who presented with intestinal obstruction of several months' duration. Complementary investigations yielded a diagnosis of intestinal obstruction due to ileocecal invagination secondary to endoluminal tumors of the ileum. Surgery and pathological analysis revealed the latter to be intestinal lipomatosis. This rare clinical entity has been associated with diverticulosis and intestinal volvulus.

[Bilateral hydronephrosis secondary to ileocolic Crohn's disease]. / Hidronefrosis bilateral secundaria a enfermedad de Crohn ileocólica.

Unilateral hydronephrosis can complicate a far from negligible number of patients with Crohn's disease. Bilateral hydronephrosis associated with Crohn's disease is a much more unusual entity. In the other hand, the treatment for this condition is still controversial. We present the case of a 44 year old female with several bowel obstruction episodes caused by ileocolic Crohn's disease. During the last episode she was also diagnosed of bilateral hydroureter and hydronephrosis. After the resolution of the bowel obstruction and the placement of a double J catheter in both ureters, the patient was operated. Ileocolic resection and bilateral ureterolysis with omental wrapping were performed. Although urinary and wound infection complicated the postoperative course, and a enterocutaneous fistula had to be medically treated one year later, the patient is now free of symptoms and her renal function is normal.

[Thromboembolic complications in inflammatory bowel disease]. / Complicaciones tromboembólicas en la enfermedad inflamatoria intestinal.

Thromboembolic complications during the course of inflammatory bowel disease are infrequent but are mainly found in young patients and are associated with a high morbimortality. The etiopathogenesis of these complications has been widely debated and the existence of coagulation alterations and fibrinolysis have been suggested. Nonetheless, the mechanism must be complex since not only do not all the patients with these alterations present this complication but neither do all the patients with thromboembolism have recognized coagulation disorders. The most common clinical presentation is deep vein thrombosis with pulmonary embolism with arterial thrombosis being rare. Five patients with Crohn's disease and two with ulcerative colitis who presented a total of new thromboembolic episodes, six arterial (1 in primitive iliac artery, 1 in common femoral artery, 1 in humeral-axillary artery, 2 in internal carotid and 1 in superior mesenteric artery) and three of venous localization (1 in brachyocephalic-subclavian trunk, 1 axillary and 1 iliac-femoral/pulmonary thromboembolism) are reported. An updated review of the etiopathogenesis, presentation, treatment and prophylaxis of the thromboembolic complications of inflammatory bowel disease is presented.

[Severe acute gastroenteritis due to Aeromonas in a patient colectomized for Crohn's disease]. / Gastroenteritis aguda grave por Aeromonas en paciente colectomizado por enfermedad de Crohn.

We report a case of severe acute diarrhoea produced by Aeromonas sobria, a specimen with controversial human pathogenicity. A 26-year-old man with Crohn's disease previously colectomized was admitted with a cholera-like clinical presentation and renal failure. Aeromonas sp. can be isolated in both children and adults and in healthy people, A. hydrophila being most often detected. Severe infections due to other Aeromonas sp., usually A. sobria and A. caviae, have been rarely described. Most patients have underlying illnesses such as chronic liver disease or neoplasms. In our patient colectomy played a key role.

[Immunosuppression therapy with cyclosporin in inflammatory bowel disease: preliminary experience]. / Tratamiento inmunosupresor con ciclosporina en la enfermedad inflamatoria intestinal (EII): experiencia preliminar.

Three patients afflicted with inflammatory bowel disease (1 UC, 1 Crohn's disease, 1 non-filiated colitis), who did not respond to the aggressive treatment from Oxford (3) were treated with immunosuppression therapy with cyclosporin. The dosage was 5-7 mg/day, to obtain seric levels (RIA) between 100-125 ng/ml during 3 months. All patients showed complete remission which was maintained for 6 months after the halt in treatment in the cases of the UC and non-filiated colitis. Parameters of cholestasis appeared with a transient increase of transaminase levels in 1 patient. Another patient suffered a pericarditis sicca which may not necessarily be related to the treatment.