Rhabdoid cavitated adenocarcinoma in the jejunum, an exceptional case by enteroscopy.

We have read the article published by Abdulkader I et al., which described two cases of a rhabdoid tumor of the small bowel diagnosed by surgery. We present a similar case in the jejunum diagnosed by double balloon enteroscopy (DBE). We present the case of a 64-year-old patient with multifactorial anemia and transfusional requirements and a flat lesion of 2 cm in the colon, which showed undifferentiated adenocarcinoma on histopathological analysis.

Gastric ulcer due to mucormycosis in a critical patient.

We have read the article published by Sánchez-Velázquez P et al., which described a clinical case of gastrointestinal hemorrhage secondary to gastric ulcer due to Mucor. We present a similar clinical case, as an example of one identified by gastroscopy. The case was a 71-year-old female with multiple organ failure secondary to nosocomial pneumonia who required mechanical ventilation, vasoactive drugs, corticosteroids, antibiotherapy and continuous venovenous hemofiltration. Her room was adjacent to a building under construction. The patient had severe upper gastrointestinal bleeding and therefore, an urgent upper gastrointestinal endoscopy was performed. A small amount of blood was identified, as well as a large ulcer without a white base extending from the fundus to the antrum region of the stomach, with bleeding due to rubbing and nodular edges that suggested degeneration.

The rebleeding rate in patients evaluated for obscure gastrointestinal bleeding after negative small bowel findings by device assisted enteroscopy.

BACKGROUND: data on the long-term outcome of patients with obscure gastrointestinal bleeding (OGIB) with positive small bowel findings in capsule endoscopy but negative small bowel findings in device-assisted enteroscopy are scarce. OBJECTIVE: this study aimed to evaluate the rebleeding rate and time to rebleed in patients with no small bowel findings in enteroscopy, after a positive capsule endoscopy in the setting of OGIB. Baseline predictors for rebleeding were assessed. METHODS: a retrospective double-center study was performed, including patients with OGIB with positive findings by capsule endoscopy and negative small bowel findings by enteroscopy. RESULTS: thirty-five patients were included. Rebleeding occurred in 40 % of patients during a median follow-up of 27 months. Further evaluation in patients with a rebleed was performed in 85.7 %, leading to a final diagnosis in 78.6 %. The rebleeding rate increased progressively over time, from 17.2 % at one month to 54.4 % at four years. Overt bleeding at the time of the first episode was a predictor of rebleeding (p = 0.03) according to the multivariate analysis. This was 50 % at one year compared with 21.8 % in patients with occult bleeding on admission. CONCLUSIONS: in obscure gastrointestinal bleeding, long-term follow-up and further evaluation may be considered after a positive capsule endoscopy. Even if there are no small bowel findings by device-assisted enteroscopy. The rebleeding rate in our study was 40 %, mainly in the presence of an overt bleeding on admission.

Recurrent small-bowel bleeding from a Dieulafoy's lesion after combined endoscopic treatment.

INTRODUCTION: Dieulafoy's lesion of the small bowel is an uncommon cause of gastrointestinal (GI) bleeding that often recurs after endoscopic treatment. MATERIAL AND METHODS: we report an observational, descriptive, retrospective, single-center study in 15 patients with small bowel bleeding who were diagnosed with a Dieulafoy's lesion by capsule endoscopy or double-balloon enteroscopy. RESULTS AND CONCLUSIONS: all patients underwent combined endoscopic treatment. During a median follow-up of 33.5 months (range, 2-145), three of the 12 cases that stayed in follow-up (25 %) recurred, all within 48 hours after treatment. Two were successfully re-treated with a repeat endoscopic procedure.

A degenerate Todani Ia choledochal cyst in a patient with pancreas divisum.

Bile duct cysts represent congenital abnormalities associated with biliopancreatic maljunction that may undergo malignant degeneration. We report herein the case of a 72-year-old male patient with cholangitis. MR-cholangiography and abdominal CT revealed a mass at the biliary-pancreatic-duodenal crossroads, extrahepatic biliary dilation up to 38 mm, and pancreas divisum. Gastroscopy found an infiltrative bulbar mucosa with adenocarcinoma in biopsy samples, and extrinsic bulging of the second duodenal portion. Endoscopic ultrasound showed a choledochal cystic dilation with solid contents, and FNA findings were nonspecific. ERCP confirmed an adenomatous papilla at the lower portion of the extrinsic formation, and a large cystic, saccular dilation of extrahepatic bile ducts (Todani Ia). Fistulotomy was required for deep cannulation of the proximal biliary tract, and attention was drawn to extruding polypoid lesions originating in the biliary epithelium, identified in biopsies as adenoma with dysplasia. Finally, a diagnosis was made of advanced adenocarcinoma in choledochal cyst.