A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco® clip and omental patch.

The growing endoscopic activity, both diagnostic and therapeutic, are also globally makes frequent endoscopic complications, perforation being one of the most serious. However, we also have more possibilities for endoscopic resolution of iatrogenic caused. We report the case of a sigmoid perforation during a colonoscopy that was resolved satisfactorily, avoiding surgery, by endoscopic closure with a nitinol clip Ovesco®.

A retrospective study of pediatric endoscopy as performed in an adult endoscopy unit.

Gastrointestinal endoscopy is a safe, efficient technique with minimal complications, and a useful diagnostic tool for the pediatric population. Under ideal conditions endoscopies for children should be performed by experienced pediatric endoscopists. In this study we report our experience with pediatric endoscopy at the general adult endoscopy unit in our hospital. Our goal is to quantify the number of endoscopies performed in children, as well as their indications and findings, the type of sedation or anesthesia used, and the time waiting for the test to occur. Our experience demonstrates that endoscopists in a general adult gastroenterology department, working together with pediatricians, may perform a relevant number of endoscopies in children in a fast, safe, effective manner.

Estudio retrospectivo sobre la endoscopia pediátrica desarrollada en un servicio de endoscopias de adultos / A retrospective study of pediatric endoscopy as performed in an adult endoscopy unit

La endoscopia gastrointestinal es una técnica segura y eficientecon mínimas complicaciones, así como una útil herramienta diagnósticaen la población pediátrica. En condiciones ideales, las endoscopiasen niños deberían ser realizadas por endoscopistas pediátricosexperimentados. En este estudio reportamos nuestraexperiencia en la realización de endoscopias pediátricas en la Unidadde Endoscopias general de adultos de nuestro hospital.El objetivo es cuantificar la cantidad de endoscopias realizadasen niños, así como las indicaciones y hallazgos de las mismas, eltipo de sedación o anestesia empleado y el tiempo de espera parala realización de la prueba. Nuestra experiencia demuestra que losendoscopistas de un servicio de gastroenterología general de adultos,en colaboración con pediatras, pueden realizar un númeroimportante de endoscopias a niños, de forma rápida, segura y eficaz(AU)

Gastrointestinal endoscopy is a safe, efficient technique withminimal complications, and a useful diagnostic tool for the pediatricpopulation. Under ideal conditions endoscopies for childrenshould be performed by experienced pediatric endoscopists. Inthis study we report our experience with pediatric endoscopy atthe general adult endoscopy unit in our hospital. Our goal is toquantify the number of endoscopies performed in children, as wellas their indications and findings, the type of sedation or anesthesiaused, and the time waiting for the test to occur. Our experiencedemonstrates that endoscopists in a general adult gastroenterologydepartment, working together with pediatricians, mayperform a relevant number of endoscopies in children in a fast,safe, effective manner(AU)

Colitis ulcerosa, tacrolimus y curación mucosa / No disponible

No disponible

Esofagitis necrotizante aguda. Una patología poco conocida / No disponible

La esofagitis necrotizante aguda (ENA) es una rara entidadcuya etiología es desconocida, siendo el mecanismo patogénicomultifactorial, participando fundamentalmente el compromiso isquémico,la malnutrición y la obstrucción del tracto digestivo alto.Los hallazgos endoscópicos muestran una coloración negruzca dela mucosa esofágica con transición brusca a nivel de la unión esofagogástrica.El pronóstico depende de las enfermedades de base.Se revisan los casos de ENA, excluyendo los secundarios a caústicos,recogidos de forma retrospectiva durante los últimos 2 años.Se analizan los factores de riesgo, la presentación clínica, los hallazgosendoscópicos, la histología, el tratamiento y la evolución.En nuestro departamento, se han diagnosticado 7 casos de ENAen 6.003 gastroscopias realizadas en el periodo de estudio, representandoasí la ENA el 0,11% de la exploraciones

Acute esophageal necrosis is a rare disorder, and its etiology isunknown, the mechanism of damage being usually multifactorialand secondary to ischemic compromise, acute gastric outlet obstruction,and malnutrition. Endoscopic findings show circumferentialblack discoloration of the distal esophagus with proximal extensionending sharply at the gastroesophageal junction, which isthe most common presentation. Prognosis depends on comorbidillnesses. In this study we analyze all cases reported in a retrospectiveanalysis over a 2-year period to define risk factors, clinicalpresentation, endoscopic features, histological appearance, treatmentand outcome. Our department has recorded 7 cases from6,003 endoscopies performed in the last 2 years. The finding of a"black esophagus" represented 0.11% of cases

Infección del espacio quirúrgico / No disponible

No disponible

[Bronchiolitis obliterans organizing pneumonia and Crohn's disease]. / Bronquiolitis obliterante con neumonía organizada y enfermedad de Crohn.

Extraintestinal respiratory manifestations in inflammatory bowel disease (IBD) are rare. We present a case of bronchiolitis obliterans organizing pneumonia (BOOP) in a patient with Crohn s disease, with clinical remission with no drug therapy.

Bronquiolitis obliterante con neumonía organizada y enfermedad de Crohn / No disponible

Las manifestaciones extraintestinales respiratorias en la enfermedadinflamatoria intestinal (EII) son excepcionales. Presentamosun caso de bronquiolitis obliterante con neumonía organizada(BONO) en paciente con enfermedad de Crohn, en remisiónclínica sin tratamientos farmacológicos

Extraintestinal respiratory manifestations in inflammatory boweldisease (IBD) are rare. We present a case of bronchiolitis obliteransorganizing pneumonia (BOOP) in a patient with Crohn’sdisease, with clinical remission with no drug therapy

[Acute esophageal necrosis. An underdiagnosed disease]. / Esofagitis necrotizante aguda. Una patología poco conocida.

Acute esophageal necrosis is a rare disorder, and its etiology is unknown, the mechanism of damage being usually multifactorial and secondary to ischemic compromise, acute gastric outlet obstruction, and malnutrition. Endoscopic findings show circumferential black discoloration of the distal esophagus with proximal extension ending sharply at the gastroesophageal junction, which is the most common presentation. Prognosis depends on comorbid illnesses. In this study we analyze all cases reported in a retrospective analysis over a 2-year period to define risk factors, clinical presentation, endoscopic features, histological appearance, treatment and outcome. Our department has recorded 7 cases from 6,003 endoscopies performed in the last 2 years. The finding of a "black esophagus" represented 0.11% of cases.

Resultados a medio largo plazo de la técnica de han en tratamiento de pacientes con varices y trombosis porto-espleno-mesentérica / HAN technique in the treatment of patients with varieces and thrombosis of portal, mesenteric and splenic veins. Results a long term

INTRODUCCIÓN. Una de las complicaciones más graves de la hipertensión portal es el sangrado digestivo por varices. Cuando la terapia endoscópica fracasa es preciso recurrir a la cirugía, con técnicas como las derivaciones o las devascularizaciones. CASO CLINICO 1: varón de 49 años con cirrosis enólica y episodios repetidos de sangrado por varices esofágicas y fúndicas. Trombosis de las venas porta, mesentérica superior y esplénica asociado a cavernomatosis portal. Se realizó devascularización esofagogástrica, fundectomía y esplenectomía. CASO CLINICO 2: mujer de 57 años con hipertensión portal por fibrosis hepática congénita. Presenta episodios repetidos de hemorragia digestiva por varices esofágicas, subcardiales y fúndicas. El tratamiento con betabloqueantes y endoscópico había fracasado. Shunt porto-cava y el TIPS (Shunt portosistémico intrahepático transyugular) no fueron capaces de controlar el sangrado por varices. Posteriormente presenta trombosis del eje espleno-portal. Finalmente se realiza devascularización esofagogástrica, fundectomía y esplenectomía. DISCUSIÓN. La endoscopia es la primera opción del tratamiento de las varices esofagogástricas. La devascularización esofagogástrica (procedimiento de Sugiura) surgió como una alternativa a las derivaciones quirúrgicas, pero tiene importantes complicaciones que aumentan la mortalidad. La fundectomía asociada a la devascularización constituye una buena alternativa,en pacientes con varices del fundus (AU)

INTRODUCTION. The digest variceal bleeding is one of the most serious complications of portal hypertension. If endoscopic therapy fails come be necessary to surgical treatment with portosystemical shunt or esophagogastric devascularization. CLINIC CASE 1. We present the case of a 49-year-old man with alcoholic cirrhosis. He had continuous episodes by oesophageal and fundal variceal bleeding. He had splenomesoportal thrombosis associated with development caverns in the portal system. We performed a periesophagogastric devascularization, fundectomy and splenectomy. CLINIC CASE 2. A 57-year-old with portal hypertension by congenital hepatic fibrosis. She had episodes of recurrent bleeding by oesophageal, subcardial and fundal variceal. Beta-blockade and endoscopy therapy had failed. The potacaval shunt and TIPS could not achieve definitive control of variceal bleeding. She had splenomesoportal thrombosis later. Finally we performed a periesophagogastric devascularization, fundectomy and splenectomy. DISCUSSION. The endoscopic therapy is the first option by treatment of esophagogastric varices. The periesophagogastric devascularization (Sugiura procedure) came up as another option to the surgical shunt, but has important complications that increase the mortality rate. The fundectomy related to devascularization is a good alternative especially for patients with fundal variceal (AU)

Cirugía con ingreso y ambulatoria: Tasas de infección en cirugía limpia / Rate of infection in clean prcedures in ambulatory surgery and patients with saty in the hospital

INTRODUCCIÓN. La cirugía mayor ambulatoria (CMA) es un modelo asistencial que permite tratar a un grupo de pacientes seleccionados, obteniendo la misma efectividad en la intervención quirúrgica sin necesidad de hospitalización. MATERIAL Y MÉTODOS. Se estudiaron 843 pacientes mediante un estudio prospectivo desde octubre de 2.000 hasta marzo de 2.005, analizando los factores de riesgo, tipos de patologías y técnicas realizadas, así como distintos aspectos relacionados con la cirugía. Realizamos una comparación entre los datos obtenidos de los pacientes sometidos a CMA y aquellos que estuvieron ingresados más de 24 horas. RESULTADOS. En ambos grupos de pacientes la patología más prevalente fue la hernia inguinal (44´5% del total de la CMA y 46´6% de la cirugía con ingreso). En los pacientes ingresados la tasa de infección fue del 2´3%, mientras que no hubo ninguna infección en la CMA. En ambos grupos se realizó un seguimiento de los pacientes durante los 30 días siguientes a la intervención quirúrgica. CONCLUSIONES. la CMA se relaciona con una menor tasa de infección de la herida, menor morbi-mortalidad, así como con una reducción de las estancia (AU)

INTRODUCTION. The ambulatory greater surgery (CMA) is a welfare model that allows to deal with a group selected patients, obtaining the same effectiveness in the operation with no need of hospitalization. MATERIAL AND METHODS. 843 patients by means of a prospective study studied from October of 2,000 to March of 2.005, analyzing the factors of risk, types of pathologies and made techniques, as well as different aspects related to the surgery. We made a comparison between the collected data of the patients submissive CMA and those that were entered more than 24 hours. RESULTS. In both groups of patients the prevalent pathology was hernia inguinal (44´5% of the total of CMA and 46´6% of the surgery with entrance). In the entered patients the rate of infection was of 2´3%, whereas there was no infection in the CMA. In both groups a pursuit of the patients was made during the 30 following days to the operation. CONCLUSIONS. the CMA is related to a smaller rate of infection of the wound, minor morbi-mortality, as well as with a reduction of the stay (AU)

Association between Whipple's disease and Giardia lamblia infection.

Whipple' disease is mainly characterized by affecting the digestive system, although it can be a multisystemic process with different clinical symptoms. The bacillus causing the disease has been isolated and cultivated in 2000 and the genome sequence has been recently analyzed in 2003, which means new perspectives for its diagnosis and treatment. Giardiasis is an infestation caused by a protozoo and may cause a malabsorption syndrome or run in a subclinic way. The case of a middle-aged male is described, who after a three-year period of migratory arthralgias, showed weight loss, diarrheas and abdominal pain, being diagnosed of Giardiasis, and after the persistent symptoms and a number of studies, was diagnosed with Whipple disease. Nineteen cases of Giardia-Whipple coinfection have been described in the literature, but the reason of this association has not been found yet. The discussion on whether there is an alteration in the immunitary system which facilitates infections or, the development of an infection lead to the other one, goes on.

Asociación de enfermedad de Whipple e infección por Giardia lamblia / Asociation between Whipple´s disease and Giardia lamblia infection

La enfermedad de Whipple se caracteriza por afectar principalmenteal aparato digestivo, aunque puede ser un proceso multisistémicocon variadas manifestaciones clínicas. En el año 2000 seha conseguido aislar y cultivar el bacilo causante y recientemente,en el 2003, se ha analizado la secuencia completa del genoma, loque supone nuevas perspectivas para el diagnóstico y el tratamiento.La giardiasis es una infección originada por un protozooque puede evolucionar de forma subclínica o dar lugar a un síndromede malabsorción.Describimos el caso de un paciente varón de mediana edad,que tras un periodo de tres años de artralgias migratorias en articulacionesperiféricas, presentó un cuadro de pérdida de peso,con aumento del número de deposiciones y molestias abdominalessiendo diagnosticado de Giardiasis y ante la persistencia de lossíntomas y la posterior realización de diferentes estudios, de enfermedadde Whipple.Están descritos en la literatura 19 casos de coinfección Giardia-Whipple, sin que en el momento actual esté aclarado el porqué de esta asociación. Se mantiene la discusión sobre si existeuna alteración en el sistema inmunitario que facilite las infeccioneso si, por otro lado, el desarrollo de una infección favorece el origende la otra

Whipple’disease is mainly characterized by affecting the digestivesystem, although it can be a multisystemic process with differentclinical symptoms. The bacillus causing the disease has beenisolated and cultivated in 2000 and the genome sequence hasbeen recently analyzed in 2003, which means new perspectivesfor its diagnosis and treatment. Giardiasis is an infestation causedby a protozoo and may cause a malabsorption syndrome or run ina subclinic way.The case of a middle-aged male is described, who after a threeyearperiod of migratory arthralgias, showed weight loss, diarrheasand abdominal pain, being diagnosed of Giardiasis, and afterthe persistent symptoms and a number of studies, wasdiagnosed with Whipple disease.Nineteen cases of Giardia-Whipple coinfection have been describedin the literature, but the reason of this association has notbeen found yet. The discussion on whether there is an alterationin the inmunitary system which facilitates infections or, the developmentof an infection lead to the other one, goes on