Manejo de la obstrucción de la salida gástrica tras esofaguectomía mediante dilatación forzada de píloro / No disponible

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Fatal upper gastrointestinal bleeding due to hepatic artery pseudoaneurysm diagnosed by endoscopy.

We report a case of fatal gastrointestinal bleeding due to hepatic artery pseudoaneurysm diagnosed by means of endoscopy in a 66-year-old male who had undergone laparoscopic cholecystectomy the previous month. We think that the image is of remarkable interest and rarity.

Gastrostomía endoscópica percutánea. Técnica e indicaciones / Percutaneous endoscopic gastrostomy. Technique and indications

En pacientes con disfagia, la gastrostomía endoscópica percutánea es superior a la sonda nasogástrica en cuanto a una mayor recuperación de peso y masa corporal, una menor mortalidad a las 6 semanas, así como una mayor comodidad y aceptación por parte del enfermo. Por su utilidad, seguridad, bajo coste y fácil mantenimiento es, en estos momentos, de elección en los pacientes con problemas de deglución. La técnica de tracción, por su sencillez, es la más utilizada. La indicación principal de colocar una gastrostomía es mantener una nutrición enteral en pacientes con sistema digestivo indemne pero que no se puedan nutrir por vía oral y en los que es previsible que su trastorno nutricional se vaya a mantener por un período superior a un mes. La indicación más frecuente es la disminución de la capacidad de ingesta, ya sea por procesos neurológicos que producen disfagia neumomotora o por enfermedad tumoral de la cavidad orofaríngea, cuello y esófago (AU)

Use of the suture anchor in modified open Bankart reconstruction.

This study describes the 2-year follow-up of Bankart reconstruction in 44 patients with posttraumatic recurrent anterior instability of the shoulder, using suture anchors and reinforcing the repair with a subscapularis overlap. Forty-three of 44 patients (98%) regained normal stability. One recurrent dislocation occurred. The mean loss of external rotation was 15 degrees. The functional results according to the Rowe scoring system were excellent in 30 cases, good in 13 cases, and poor in 1 case. The suture anchors were found to simplify the procedure.

Duodenal obstruction secondary to a metastasis from an adenocarcinoma of the cecum: a case report.

Metastatic tumors to the gastrointestinal tract are rare; the stomach and small bowel are the most common organs involved. Lung cancer, renal cell carcinoma, breast carcinoma, and malignant melanoma are the most common primary tumors metastatic to the duodenum. We report a metastasis to the duodenum from an adenocarcinoma of the cecum presenting as a duodenal obstruction 4.5 yr after the surgical resection of the primary tumor. The condition of the patient was temporarily controlled with the implantation of an endoduodenal metallic prosthesis as a palliative measure.

Visceral leishmaniasis diagnosed by colonoscopy.

Zoonotic visceral leishmaniasis is common in western Mediterranean countries. A strong link between visceral leishmaniasis and human immunodeficiency virus (coinfection) has been proved, especially in Spain, which is an endemic area. This suggests that Leishmania may behave opportunistically. We report a case of colonic leishmaniasis in a 23-year-old Spanish woman infected with the human immunodeficiency virus.

[Sclerosing hepatocarcinoma not associated with hypercalcemia]. / Hepatocarcinoma esclerosante no asociado a hipercalcemia.

The sclerosing hepatocellular carcinoma is an unusual subtype of hepatocellular carcinoma characterized by an intense fibrous stroma in which the tubular structures are embedded. Histological diagnosis is difficult, and misinterpretation as cholangiocarcinoma or metastatic adenocarcinomas may occur. It usually presents on non-cirrhotic livers. Metastases located outside of the liver are frequent as well as hypercalcemia and low levels of serum phosphate. We report a case of this rare histopathologic subtype of hepatocellular carcinoma in a 35-year-old woman, asymptomatic and with no previous history of chronic liver disease. It was detected by a routine gynaecological ultrasonography. An important increase of serum alpha-fetoprotein was noted. Extension studies showed bilateral lung metastases. Several palliative therapies were tried out, including epirrubicin, with partial response. Twenty months after the diagnosis the patient's situation is nearly terminal.

[Diffuse gastrointestinal angiodysplasia associated with cryptogenic hepatic cirrhosis and coagulopathy simulating von Willebrand disease]. / Angiodisplasia gastrointestinal difusa asociada a cirrosis hepática criptogenética y coagulopatía que simulaba una enfermedad de von Willebrand.

Angiodysplasic lesions can be located anywhere in the gastrointestinal tract, but most of them are found in the cecum and right colon. Angiodysplasias are very infrequent in the stomach and small bowel. These lesions can be associated with several clinical conditions, such as certain coagulation disorders and liver diseases. We report the case of a diffuse gastrointestinal angiodysplasia in a female patient with idiopathic cirrhosis of the liver who developed a coagulopathy which mimicked von Willebrand disease. After repeated blood transfusions, which were not able to control the anemia of the patient, an antrectomy was performed because most lesions were located in the antrum. The procedure did not achieve a suitable control of the bleeding. Finally, a hormonal therapy combining estrogens and progestagens, was able to control, at least partially, the patient's chronic gastrointestinal bleeding.