Endoscopic suspect of subacute occlusive mesenteric ischemia.

A 74-year-old patient presented to our emergency department with melena for 24 hours, associated with postprandial abdominal pain, predominantly in the epigastrium, for one month. Urgent gastroscopy showed a pale mucosa with loss of vascular pattern in the gastric antrum, as well as several superficial ulcers, Forrest III, at that level and in the duodenal bulb highly suggestive of ischaemia. An abdominal computed tomography angiography (CTA) revealed a filiform celiac trunk, with calcified atherosclerotic plaques in the ostium, superior mesenteric artery and both renal arteries, with absence of enhancement in a large part of the intestinal wall, suggestive of ischaemia. An exploratory laparoscopy confirmed patchy ischaemia of the small intestine, as well as of the cecum, ascending colon, and portion of the transversus. Atherosclerosis is the most common cause of occlusive chronic mesenteric ischaemia. The 'classic triad' consisting of postprandial pain, weight loss and abdominal bruit, is found in only a minority of patients, with a significant percentage of paucisymptomatic patients due to abundant colateral circulation, making diagnosis difficult. The endoscopic finding of edema, erythema or signs of mucosal atrophy, as well as gastric or duodenal ulcers, not justified by other causes can guide us in the diagnosis. However, more distal sections of the digestive tract which are not accessible with the conventional endoscope can often be affected, and the absence of these findings, does not exclude the diagnosis. Abdominal CTA is the gold-standard imaging test. Early diagnosis of mesenteric ischaemia is a challenge in clinical practice. Recognizing its endoscopic signs can facilitate its early diagnosis and treatment.

Colostomía endoscópica percutánea como tratamiento de un vólvulo de sigma recidivante en paciente casi centenario / No disponible

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Percutaneous endoscopic colostomy to treat recurrent sigmoid volvulus in an almost centenary patient.

We report the case of a 96-year-old institutionalized male, with severe dementia, who was admitted to our hospital with sigmoid volvulus. After successful decompression, the patient developed recurrent sigmoid volvulus twice within 76 hours, which required endoscopic repositioning. However, after a new recurrence and rejecting surgery, we chose percutaneous endoscopic colostomy, using the standard gastrostomy technique, in order to fix the mobile intestine to the abdominal wall to prevent torsion. Although observational studies with more cases and longer follow-up are needed, percutaneous endoscopic colostomy could be a safe and effective alternative in patients in whom conventional surgery is considered unsafe or inappropriate.

Involvement of the digestive system in covid-19. A review. / Afectación del aparato digestivo en la covid-19. Una revisión sobre el tema.

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed.

Afectación del aparato digestivo en la covid-19. Una revisión sobre el tema / Involvement of the digestive system in covid-19. A review

La pandemia por el SARS-CoV-2 está conllevando una elevada mortalidad y suponiendo una crisis sanitaria a nivel mundial. La afectación fundamental es respiratoria; sin embargo, el virus también puede afectar a otros órganos, como el tracto gastrointestinal y el hígado. Los síntomas más habituales son anorexia y diarrea. Aproximadamente, en la mitad de los casos se podría detectar ARN viral en heces, lo que constituye otra línea de transmisión y diagnóstico. La covid-19 tiene peor pronóstico en pacientes con comorbilidades, aunque no existe evidencia suficiente en caso de enfermedades digestivas previas. Las endoscopias digestivas pueden originar aerosoles, lo que las convierte en técnicas con elevado riesgo de infección. Expertos y organizaciones científicas a nivel mundial han elaborado guías de funcionamiento para adoptar medidas de prevención. Se revisan las evidencias disponibles sobre la afectación gastrointestinal y hepática, la repercusión en pacientes con enfermedades digestivas previas y las guías de funcionamiento para las unidades de endoscopia durante la pandemia

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed

Citomegalovirus asociado a úlcera gástrica: caso clínico y revisión de la literatura / Cytomegalovirus associated with gastric ulcer: case report and literature review

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