Upper gastrointestinal bleeding and Rigler triad.

Gallstone ileus is a rare complication of cholelithiasis, characterized by mechanical bowel obstruction due to a biliary calculus originating from a bilioenteric fistula. The Rigler triad, consisting of aerobilia, ectopic gallstone, and intestinal obstruction, is rarely observed in its complete form. We present the case of a 92-year-old male with a history of acute lithiasic cholecystitis who presented to the Emergency department with acute epigastric pain. Initial evaluation revealed gallbladder dilatation, gallstones, and gallbladder wall thickening suggestive of acute cholecystitis. During hospitalization, the patient experienced an episode of hematemesis, leading to the diagnosis of a cholecystoduodenal fistula and a large blood clot in the duodenal bulb. Further imaging showed an ectopic gallstone causing small bowel obstruction. The patient underwent urgent surgery for stone extraction, followed by endoscopic intervention for the bleeding vessel identified at a subsequent gastroscopy. Unfortunately, the patient had a poor postoperative course and passed away seven days later. This case report highlights the exceptional occurrence of both the Rigler triad and upper gastrointestinal bleeding in a patient with gallstone ileus. Surgical intervention is crucial for the initial resolution of intestinal obstruction, followed by cholecystectomy and repair of the bilioenteric fistula. Awareness of these rare presentations is important for timely diagnosis and appropriate management of this uncommon complication of cholelithiasis.

Large bowel obstruction secondary to a simple renal cyst: an exceptional complication.

We report the case of an 81-year-old female with large bowel obstruction secondary to a giant simple renal cyst (16 cm), which was producing a compression of the descending colon against the abdominal wall. Percutaneous drainage of the renal cyst was performed by a urologist. The follow-up CT scan revealed a collapsed cyst with resolution of the bowel obstruction. The patient showed resolution of the symptoms with an improvement in blood test results.

McKittrick-Wheelock syndrome: rectal villous adenoma as a cause of acute renal failure.

We report the case of a 67-year-old male with a history of arterial hypertension and atrial fibrillation, who was admitted for acute renal failure (creatinine: 4.41 mg/dl) and hypotension. He also presented hyponatremia (129 mmol/L) and hypokalemia (2.7 mmol/L). The patient referred profuse diarrhea during the previous two months as a possible triggering cause. Physical examination showed signs of dehydration and palpation of a polypoid mass in the rectal ampulla.

Shock séptico secundario a síndrome de Mirizzi resuelto en 2 tiempos / Septic shock secondary to Mirizzi syndrome resolved in two stages

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Estenosis anastomótica de gastroyeyunostomía derivativa resuelta con endoprótesis tipo yo-yo / Derivative anastomotic gastrojejunostomic stenosis resolved with a yo-yo type stent

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[Mycobacterium kansasii infection after liver transplantation]. / Infección por Mycobacterium kansasii tras el trasplante hepático.

Infections are one of the leading causes of morbidity and mortality in solid organ transplant recipients because of treatment with immunosuppressive agents. Infections due to nontuberculous mycobacteria (NTM) are infrequent but may be a major cause of morbidity. Treatment is associated with therapeutic limitations due to drug interactions with immunosuppressive agents and enhanced toxicity. Treatment of NTM infection most commonly involves surgery, reducing the doses of immunosuppressive medications and/or therapy with antimycobacterial medications The American Thoracic Society recommends isoniazid, rifampicin, and ethambutol. The current duration for treatment of pulmonary disease caused by Mycobacterium kansasii is 18 months. We describe the case of an immunosuppressed liver transplant recipient with poor outcome due to acute cholangitis who also developed concomitant infection with an uncommon organism, M. kansasii, in the late posttransplantation period.

Infección por Mycobacterium kansasii tras el trasplante hepático / Micobacterium kansasii infection after liver trasplantation

Las infecciones son una de las principales causas de morbilidad y mortalidad en pacientes trasplantados, dado el tratamiento con terapia inmunosupresora. Las infecciones por micobacterias no tuberculosas (MNT) son infrecuentes, pero pueden causar una gran morbilidad. El tratamiento está asociado a limitaciones terapéuticas debido al aumento de toxicidad y a las interacciones con el tratamiento inmunosupresor. Las infecciones por MNT pueden tratarse con cirugía, reduciendo la dosis de inmunosupresores y/o con antimicobacterianos. La American Thoracic Society (ATS) recomienda tratamiento con isoniazida, rifampicina y etambutol, que debe mantenerse durante 18 meses en el caso de infección pulmonar por Mycobacterium kansasii. Presentamos a continuación el caso clínico de un paciente inmunodeprimido a causa de un trasplante hepático, con evolución infausta debido a una colangitis aguda, que presentó además una infección respiratoria concomitante por un microorganismo poco frecuente, M. kansasii, en el período tardío postrasplante (AU)

Infections are one of the leading causes of morbidity and mortality in solid organ transplant recipients because of treatment with immunosuppressive agents. Infections due to nontuberculous mycobacteria (NTM) are infrequent but may be a major cause of morbidity. Treatment is associated with therapeutic limitations due to drug interactions with immunosuppressive agents and enhanced toxicity. Treatment of NTM infection most commonly involves surgery, reducing the doses of immunosuppressive medications and/or therapy with antimycobacterial medications The American Thoracic Society recommends isoniazid, rifampicin, and ethambutol. The current duration for treatment of pulmonary disease caused by Mycobacterium kansasii is 18 months. We describe the case of an immunosuppressed liver transplant recipient with poor outcome due to acute cholangitis who also developed concomitant infection with an uncommon organism, M. kansasii, in the late posttransplantation period (AU)

Retinopatía de Purtscher asociada a pancreatitis aguda / Purtscher’s retinopathy associated with acute pancreatitis

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Importancia de la resonancia magnética en el diagnóstico de la microhamartomatosis biliar múltiple (complejos de von Meyenburg) / Importance of magnetic resonance imaging in the diagnosis of multiple small biliary hamartomas (von Meyenburg complexes)

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