Plexiform fibromyxoma, a rare mesenchymal gastric tumor / Fibromixoma plexiforme, un tumor gástrico mesenquimal poco frecuente

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Hemoperitoneo: una complicación infrecuente de la colonoscopia diagnóstica / Hemoperitoneum: A rare complication after diagnostic colonoscopy

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Colitis por Aeromonas hydrophila como primera manifestación de un cáncer de colon / Aeromonas hydrophila colitis as the initial presentation of colon cancer

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Talidomida en dosis altas para la hemorragia digestiva oscura grave idiopática en una paciente de alto riesgo trombótico / High-dose thalidomide for severe idiopathic obscure gastrointestinal bleeding in a patient at high-thrombotic risk

Se presenta el caso de una mujer de 81 años con accidentes vasculares cerebrales (ACV) recurrentes con doble antiagregación y hemorragia digestiva de origen oscuro. No se encontró el origen del sangrado con cápsula endoscópica, enteroscopia de doble balón, laparotomía exploradora y enteroscopia intraoperatoria bidireccional desde boca a ano. La paciente requirió la transfusión de 117 concentrados de hematíes durante 2 años pese a suspensión de la medicación antiagregante y tratamiento con análogos de la somatostatina. Por ello, se inició terapia con dosis crecientes de talidomida, hasta 300mg, asociadas a profilaxis tromboembólica durante 3 meses, sin respuesta. Al suspender la heparina, la hemorragia se controló durante 3 meses, pero se retiró la talidomida por efectos secundarios. Dado que la hemorragia recidivó al mes de la suspensión, se realizó un segundo ciclo de 3 meses de tratamiento con talidomida. Durante un año de seguimiento, la paciente no ha precisado transfusión de hemoderivados (AU)

We report the challenging case of an 81-year-old woman on dual antiplatelet therapy with recurrent strokes, who presented with severe obscure gastrointestinal bleeding. A thorough diagnostic work-up, including capsule endoscopy, double balloon enteroscopy, arteriography, exploratory laparotomy and mouth-to-anus intraoperative enteroscopy, failed to reveal the source of the bleeding. During a 2-year period, the patient required 117 packed red blood cell units, despite withdrawal of antiplatelet drugs and empirical therapy with high-dose somatostatin analogues. The patient was administered an increasing dosage of thalidomide, up to 300mg/day, with thromboembolism prophylaxis for 3 months, with no clinical response. The bleeding stopped for 3 months after heparin was discontinued, but thalidomide had to be withdrawn owing to adverse effects. Since bleeding recurred a month later, the patient underwent another 3-month course of thalidomide. The patient has not required further blood transfusion after a 1-year follow-up (AU)

[High-dose thalidomide for severe idiopathic obscure gastrointestinal bleeding in a patient at high-thrombotic risk]. / Talidomida en dosis altas para la hemorragia digestiva oscura grave idiopática en una paciente de alto riesgo trombótico.

We report the challenging case of an 81-year-old woman on dual antiplatelet therapy with recurrent strokes, who presented with severe obscure gastrointestinal bleeding. A thorough diagnostic work-up, including capsule endoscopy, double balloon enteroscopy, arteriography, exploratory laparotomy and mouth-to-anus intraoperative enteroscopy, failed to reveal the source of the bleeding. During a 2-year period, the patient required 117 packed red blood cell units, despite withdrawal of antiplatelet drugs and empirical therapy with high-dose somatostatin analogues. The patient was administered an increasing dosage of thalidomide, up to 300 mg/day, with thromboembolism prophylaxis for 3 months, with no clinical response. The bleeding stopped for 3 months after heparin was discontinued, but thalidomide had to be withdrawn owing to adverse effects. Since bleeding recurred a month later, the patient underwent another 3-month course of thalidomide. The patient has not required further blood transfusion after a 1-year follow-up.