Gastric calcinosis ulcer in a renal transplanted patient.

A 53-year-old lady with dysfunctional renal transplant and post-surgical hypoparathyroidism with phosphocalcic metabolism impairment was admitted to hospital because of long-lasting epigastric pain and nausea. An esophagogastroduodenoscopy was performed, visualising a nodular lesion of 1 cm diameter with a depressed and ulcerated base. Microscopically the lesion was in relation with a metastatic calcinosis ulcer. Pantoprazole was initiated and serum phosphocalcic levels adjusted, achieving symptom remission. In the follow-up esophagogastroduodenoscopy, the lesion was healing with a fibrinous base and the histopathological report diagnosed superficial gastritis.

Endoscopic resolution of intestinal obstruction secondary to colonic gallstone ileus and radicular stenosis of the sigma.

A 93-year-old woman with a history of endometrial adenocarcinoma treated with surgery and pelvic radiotherapy that led to radicular stenosis in the sigma and acute biliary pancreatitis, without subsequent cholecystectomy. She attended the emergency department for abdominal pain, vomiting and abdominal distension, with metallic noises. An abdominal CT scan showed a gallbladder with cholelithiasis, in wide contact with the colonic framework and dilation of the colonic loops with hydro-aerial levels with a partially calcified image embedded in the known sigmoid stenosis, compatible with intestinal obstruction. Given the high surgical risk, colonoscopy was performed, which identified an impassable punctate stricture with a fibrous appearance. Pneumatic dilatation and subsequent removal of gallstones with biopsy forceps was performed, with an adequate evolution. While gallstone ileus is a rare condition that accounts for 5% of episodes of intestinal obstruction, its location in the colon is even rarer. It is usually managed surgically, with a significant impact on morbidity. This case is of interest because of the infrequent occurrence of obstruction secondary to these two concomitant causes and the possible usefulness of endoscopic treatment in patients at high surgical risk.

Sedation assisted by an endoscopist (SAE) for complex endoscopic procedures. Is it time to change the current guidelines?

Currently, sedation in endoscopic procedures is considered a necessary condition and a criterion of quality in digestive endoscopy. The role of SAE in conventional endoscopic procedures is clearly established in clinical guidelines, but this is not so clear in complex endoscopic procedures, such as ERCP. In recent years, numerous studies have been published, with results similar to those noticed in this article, endorsing the safety, efficacy and efficiency of SAE, when performed by properly trained staff.

Dolor torácico, un síntoma poco habitual de coledocolitiasis / Chest pain, an unusual symptom of choledocholithiasis

La litiasis biliar en Pediatría es una patología de baja incidencia. El diagnóstico se suele producir de forma casual debido a que cursa en la mayor parte de los casos de forma asintomática. En ocasiones, el síntoma de debut es en forma de dolor torácico, si bien esta circunstancia es poco frecuente. El método diagnóstico más utilizado es la ecografía abdominal debido a su alta especificidad y sensibilidad. El tratamiento depende de las características del paciente, pudiendo plantear opciones tanto médicas como quirúrgicas (AU)

Cholelithiasis in paediatrics is a pathology that has a low incidence. Diagnosis is usually made by chance as it is mostly asymptomatic. Chest pain as presenting symptom is rare. The most commonly used diagnostic method is abdominal ultrasound due to its high specificity and sensitivity. Treatment depends on the characteristics of the patient, and both medical and surgical options may be considered. (AU)

Sedación asistida por endoscopista (SAE) en procedimientos endoscópicos complejos. ¿Es el momento de modificar las guías actuales? / Sedation assisted by an endoscopist (SAE) for complex endoscopic procedures. Is it time to change the current guidelines?

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Resolución endoscópica de cuadro de obstrucción intestinal secundario a íleo biliar colónico y estenosis rádica en sigma / Endoscopic resolution of intestinal obstruction secondary to colonic gallstone ileus and radicular stenosis of the sigma

Mujer, 93 años, con antecedentes de adenocarcinoma de endometrio tratado con cirugía y radioterapia pélvica que condiciona estenosis rádica en sigma y pancreatitis aguda biliar, sin colecistectomía posterior. Acude a Urgencias por cuadro de dolor abdominal, vómitos y distensión abdominal, con ruidos metálicos. En TC abdominal se objetiva vesícula con colelitiasis, en amplio contacto con el marco cólico y dilatación de asas colónicas con niveles hidroaéreos con imagen parcialmente calcificada enclavada en la estenosis de sigma conocida, compatible con obstrucción intestinal. Dado el elevado riesgo quirúrgico, se realiza colonoscopia que identifica estenosis puntiforme infranqueable de aspecto fibroso. Se procede a dilatación neumática y posterior retirada de cálculos biliares con pinza de biopsia, con adecuada evolución. Mientras que el íleo biliar es un cuadro raro que condiciona el 5% de los episodios de obstrucción intestinal, su localización en el colon es aún más infrecuente. Su manejo habitual es quirúrgico, con significativo impacto en morbilidad. Este caso resulta de interés por lo infrecuente de la obstrucción secundaria a estas dos causas concomitantes y la posible utilidad del tratamiento endoscópico en pacientes de alto riesgo quirúrgico. (AU)