Endoscopic endoluminal therapy with the Eso-SPONGE® system for the treatment of spontaneous esophageal perforation with associated paraoesophageal collection.

We present the case of a 92-year-old woman with no relevant history, who consulted for sore throat, progressive dysphagia to solids and fever. A cervical-thoraco-abdominal CT was performed with the finding of a paraesophageal collection at the level of C3-T1 without a clear solution of continuity, although with passage of oral contrast to the collection, exerting a mass effect on the esophageal lumen, suggestive of contained esophageal perforation, of cause not clarified. A gastroscopy was performed, in which three esophageal fistulous orifices were observed, two 4-5 mm, and a third 10 mm deeper, located 22cm from the dental arch, septate, with perilesional purulent material and bubbling.

Capecitabine-induced hyperammonemic encephalopathy.

We report the case of a 79-year-old male who had undergone surgery for a mucus-secreting, stage-III pancreatic adenocarcinoma 2 years previously, who was recently started on capecitabine monotherapy for radiographic local progression. He developed disorientation, asterixis, nausea and elevated serum ammonia (221 µmol/L) 48-72 hours after treatment onset with preserved liver function. After ruling out potential causes of encephalopathy and tumor progression by abdominal and brain CT scans, his symptoms were related by exclusion to the recently initiated treatment with capecitabine. Capecitabine discontinuation, onset of standard anti-encephalopathy measures, and intravenous hydration led to a rapid, complete resolution of symptoms with serum ammonia normalization.