[Obstructive jaundice after cholecystectomy]. / Ictericia obstructiva en mujer colecistectomizada.

In this article we present the case of a 72 year-old woman who three years after laparoscopic cholecystectomy develops obstructive jaundice. An MRI of the liver and biliary system revealed an hiliar mass that caused dilatation of the biliary tree. The patient underwent hepatic duct resection and reconstruction via hepaticojejunostomy. The histological examination of the surgical specimen identified an intramural biliary neuroma with no evidence of malignancy.

[Recurrent pneumonia secondary to idiopathic bronchomalacia]. / Neumonías recurrentes secundarias a broncomalacia idiopática.

Bronchomalacia in adults develops secondary to bronchial disease processes (chronic bronchitis, tuberculosis, neoplasm) or to lesions resulting from prolonged intubation, surgery, trauma, or lung transplantation. We report the case of an 84-year-old woman with no history of any of the aforementioned associations in whom we detected severe idiopathic bronchomalacia of the main left bronchus. The identified lesion caused recurrent pneumonias leading to death. We show images obtained by bronchoscopy, revealing the severity of the lesion and its functional repercussions.

[Meningoencephalitis due to Rickettsia conorii. Etiopathological, clinical and diagnostic aspects]. / Meningoencefalitis por Rickettsia conorii. Aspectos etiopatogénicos, clínicos y diagnósticos.

Boutonneuse fever (BF) is usually considered to be a benign rickettsiosis. However, severe presentations, resembling Rocky Mountain spotted fever, have been reported. There are few neurological complications, except in serious forms of the disease. We present a case of meningoencephalitis in a male adult suffering from BF, and we review the clinical, etiopathogenic and diagnostic aspects among the cases previously reported. We conclude that BF encephalitis would have the following characteristics: a) they mostly affect elderly males; b) they cause altered consciousness level, headaches and low rate of meningeal signs; c) absence of "tâche noir"; d) cerebrospinal fluid with slight pleocytosis and/or increased level of proteins, and normal glucose values; e) computerized tomography without significative changes, and f) high rate of morbidity and mortality. We emphasize that we should consider BF in the differential diagnosis of our environmental encephalitis.