Strangulated volvulus of the sigmoid colon with inviable mucosal appearance in a non-surgical patient. Endoscopic devolvulation.

Colonoscopy is presently always performed before surgical management of a volvulus in the sigmoid colon. It leads to know the viability of the mucosa and, when possible, to resolve the volvulus conservatively. Besides, with endoscopic control, we can place a decompression tube proximal to the volvulated sigmoid colon, favouring a non-surgical resolution. With this conservative approach it is possible to overcome the acute period, and to restore the viability of the sigmoid wall, waiting for a definitive surgical management with less morbidity and mortality. Only with endoscopy, revolvulation does occur in 35-50% of cases. We present the clinical case of a sigmoid volvulus with compromised sigmoid wall in an 82-year-old man with several clinical problems contraindicating surgery. Endoscopic devolvulation with tube placement was adequate to resolve this sigmoid volvulus.

Vólvulo de sigma estrangulado con mucosa de apariencia inviable en paciente no subsidiario de tratamiento quirúrgico. Devolvulación endoscópica / Strangulated volvulus of the sigmoid colon with inviable mucosal appearence in a non-surgical patient. Endoscopic devolvulation

Actualmente la colonoscopia se realiza previamente al manejo quirúrgico de los vólvulos de sigma. Ello permite conocer el estado de la mucosa del colon volvulado, su viabilidad y, en ocasiones, resolver la volvulación de forma conservadora. Asimismo, mediante control endoscópico se puede dejar en posición un tubo de descompresión, colocado proximalmente al área volvulada, favoreciendo la resolución sin cirugía. Mediante este manejo conservador es posible superar el periodo agudo y recuperar la viabilidad de la pared del colon, evitando la cirugía urgente donde la morbimortalidad es mayor. El tratamiento endoscópico solamente no suele ser suficiente como solución definitiva apareciendo recidiva de la volvulación en el 3050 por ciento de los casos. Presentamos el caso de un vólvulo de sigma estrangulado, con compromiso de la pared colónica, en un paciente de 82 años de edad, con múltiples patologías de base que contraindicaban la cirugía. La devolvulación endoscópica, dejando en posición un tubo de descompresión, permitió la resolución del cuadro, sin recidiva posterior (AU)

[Delayed reposition of gastrostomy tube using Savary's dilators]. / Reposición diferida de sonda de gastrostomía utilizando dilatadores de Savary.

The delay in substituting a gastrostomy tube after removal leads to the gastrocutaneous tract closure and to the impossibility of putting other nourishment tube without needing another complete endoscopic procedure. We have used the technique described by Tsang through the one which and using Savary's dilators, the stenosed gastrocutaneous tract after accidental removal of the tube, is dilated permitting to put in a simple way a new one. We accomplished the procedure in three patients that attended by removal of the probe and severe stenosis of the stoma. In all they and under endoscopic control we put a new tube in a way rapid and without complications.

[Transpapillary endoscopic drainage of pancreatic pseudocyst]. / Drenaje endoscópico transpapilar de un pseudoquiste pancreático.

Drainage of pancreatic pseudocysts can be achieved by means of endoscopy. In this paper we report a case of a pancreatic pseudocyst of ten centimeters in diameter, that was successfully managed by insertion of a nasocystic drainage through the papilla of Vater. The procedure was simple and complications were absent. Transpapillary drainage of pancreatic pseudocysts is an effective procedure.

[Polyarteritis nodosa in a woman with temporal arteritis]. / Poliarteritis nodosa en mujer con arteritis temporal.

A case of a 74-year-old woman, with a histological diagnosis of Transient Arteritis two years before and Nodose Polyarteritis, is described. Although the coexistance of these two vasculitis in a same patient has been rarely described in the literature, we considered that the diagnostic suscpiction of Nodose Polyarteritis should be maintained in a patient with Transient Arteritis developing multisystemic signs.