[Jejunal phlebectasia as a cause of massive gastrointestinal haemorrhage]. / Flebectasia yeyunal como causa de hemorragia digestiva media masiva.

Vascular abnormalities of the gastrointestinal tract are a common cause of gastrointestinal bleeding. Most of them are located within the reach of the upper endoscopy or colonoscopy, although once discarded, it forces to consider small bowel as the source of bleeding. The successful management of a gastrointestinal bleeding depends mainly on the timely location of the source of bleeding. Nevertheless this task can be difficult when the cause is not within the reach of conventional methods. We present a case of a 21 year-old men in which the diagnosis of bleeding yeyunal phlebectasia was made by the findings of the capsule endoscopy and laparoscopy.

Flebectasia yeyunal como causa de hemorragia digestiva media masiva / Jejunal phlebectasia as a cause of massive gastrointestinal hemorrhage

Las anormalidades vasculares del tracto gastrointestinal son una causa común de sangrado digestivo. La mayoría se localizan al alcance de la endoscopía digestiva alta y/o colonoscopía, una vez descartado ello, obliga a considerar al intestino delgado como causa de la hemorragia. El manejo exitoso de una hemorragia digestiva depende principalmente de la localización oportuna de la fuente del sangrado, sin embargo esta tarea puede ser difícil, cuando la causa no está al alcance de los métodos convencionales. Presentamos el caso de un paciente varón de 21 años cuyo diagnóstico fue una flebectasia yeyunal sangrante, luego de una cuidadosa evaluación de los hallazgos de la cápsula endoscópica y laparoscopía.

Vascular abnormalities of the gastrointestinal tract are a common cause of gastrointestinal bleeding. Most of them are located within the reach of the upper endoscopy or colonoscopy, although once discarded, it forces to consider small bowel as the source of bleeding. The successful management of a gastrointestinal bleeding depends mainly on the timely location of the source of bleeding. Nevertheless this task can be difficult when the cause is not within the reach of conventional methods. We present a case of a 21 year-old men in which the diagnosis of bleeding yeyunal phlebectasia was made by the findings of the capsule endoscopy and laparoscopy.

[Fulminating ischemic hepatitis induced by severe cardiac dysfunction: case report]. / Hepatitis isquémica fulminante inducida por disfunción cardiaca severa: reporte de caso.

Ischemic Hepatitis is an uncommon entity in daily clinical practice with a prevalence of 0.16 to 0.5% among patients admitted to a critical care unit, associated with an approximate 60% mortality rate. This liver disease is characterized by a rapid and marked increase (more than 20 times the normal value) of the level of transaminases secondary to a severe and persistent hepatic hypoperfusion caused by multiple etiologies, which may be transient when the triggering cause is timely identified and appropiately treated. The case of an elderly adult patient with a clinical, epidemiological and biochemical profile compatible with ischemic hepatitis secondary to severe cardiac dysfunction is presented below.

Anemia ferropénica severa asintomática como presentación inusual de divertículo de Meckel / Severe asymptomatic iron deficiency anemia as an unusual presentation of a Meckel diverticulum

El divertículo de Meckel es un diagnóstico poco frecuente dentro de la práctica clínica diaria. Sin embargo, debe ser considerado dentro del diagnóstico diferencial de todo paciente que acude por hemorragia digestiva oscura, tanto manifiesta como oculta. Anteriormente, el intestino delgado era inexplorable; en la actualidad, su evaluación es posible gracias a nuevos métodos diagnósticos: cápsula endoscópica, enteroscopía, enterotomografía y enteroresonancia. La cápsula endoscópica no permite tomar biopsias, es un examen sin insuflación, no controlado y depende mucho de la interpretación del evaluador. Sin embargo, dentro del algoritmo diagnóstico de todo paciente con hemorragia digestiva oscura, la cápsula endoscópica suele ser el estudio inicial, por ser mínimamente invasiva y por permitirnos definir la mejor ruta de abordaje para realizar procedimientos posteriores, como la enteroscopía asistida por balón (simple o doble) que nos permite profundizar la evaluación del intestino delgado, tomar biopsias y hacer medidas terapéuticas. Como veremos, la cápsula endoscópica y la enteroscopía asistida por balón son complementarios y no excluyentes en todo paciente con hemorragia oscura. En este reporte presentamos el caso de un paciente adulto joven, asintomático, deportista, que en un examen de rutina evidenció anemia severa por deficiencia de hierro, sin historia de pérdidas gastrointestinales manifiestas. La evaluación del intestino delgado, mediante cápsula endoscópica y enteroscopía asistida por balón, nos permitió demostrar la presencia de un divertículo de Meckel ulcerado, y una laparoscopia orientada por los hallazgos nos permitió un tratamiento efectivo y una evolución favorable de esta presentación poco frecuente.

Meckel's diverticulum is a rare clinical entity in clinical practice. However, it should be considered as an important differential diagnosis in patients with both obscure overt and occult gastrointestinal bleeding. Years ago, the evaluation of the small bowel was impossible without surgery, nowadays the development of new diagnostic methods has changed this horizon. Capsule endoscopy cannot take biopsies, has not bowel insufflation, and its final report depends a lot on the interpretation of the evaluator. However, capsule endoscopy is usually the first procedure in all patients with obscure gastrointestinal bleeding, because is minimally invasive, and it has a main role in predicting the better route to perform a balloon assisted enteroscopy (single or double) that allows us to explore the small bowel, take biopsies and do therapeutic procedures. Capsule endoscopy and balloon assisted enteroscopy are complementary procedures in every patient with obscure gastrointestinal bleeding. In this report, we present a case of young adult without history of gastrointestinal bleeding who had severe asymptomatic iron deficiency anemia, in which the evaluation of small bowel with capsule endoscopy and balloon-assisted enteroscopy allow us to diagnosis ulcerated Meckel diverticulum.

Hepatitis isquémica fulminante inducida por disfunción cardiaca severa: reporte de caso / Fulminating ischemic hepatitis induced by severe cardiac dysfunction: case report

La hepatitis isquémica es una entidad infrecuente en la práctica clínica diaria con una prevalencia de 0,16 a 0,5% entre los pacientes admitidos en unidad de cuidados críticos, asociado a una mortalidad aproximada en el 60% de los casos. Esta hepatopatía se caracteriza por un incremento rápido y marcado (más de 20 veces el valor normal) del nivel de transaminasas secundario a una hipoperfusión hepática severa y persistente ocasionada por múltiples etiologías, que puede ser transitoria de identificarse y tratar la causa desencadenante oportunamente. A continuación presentamos el caso de un paciente adulto mayor con un cuadro clínico, epidemiológico y bioquímico compatible con hepatitis isquémica secundario a disfunción cardiaca severa.

Ischemic Hepatitis is an uncommon entity in daily clinical practice with a prevalence of 0.16 to 0.5% among patients admitted to a critical care unit, associated with an approximate 60% mortality rate. This liver disease is characterized by a rapid and marked increase (more than 20 times the normal value) of the level of transaminases secondary to a severe and persistent hepatic hypoperfusion caused by multiple etiologies, which may be transient when the triggering cause is timely identified and appropiately treated. The case of an elderly adult patient with a clinical, epidemiological and biochemical profile compatible with ischemic hepatitis secondary to severe cardiac dysfunction is presented below.

[Severe asymptomatic iron deficiency anemia as an unusual presentation of a Meckel diverticulum]. / Anemia ferropénica severa asintomática como presentación inusual de divertículo de Meckel.

Meckel's diverticulum is a rare clinical entity in clinical practice. However, it should be considered as an important differential diagnosis in patients with both obscure overt and occult gastrointestinal bleeding. Years ago, the evaluation of the small bowel was impossible without surgery, nowadays the development of new diagnostic methods has changed this horizon. Capsule endoscopy cannot take biopsies, has not bowel insufflation, and its final report depends a lot on the interpretation of the evaluator. However, capsule endoscopy is usually the first procedure in all patients with obscure gastrointestinal bleeding, because is minimally invasive, and it has a main role in predicting the better route to perform a balloon assisted enteroscopy single or double) that allows us to explore the small bowel, take biopsies and do therapeutic procedures. Capsule endoscopy and balloon assisted enteroscopy are complementary procedures in every patient with obscure gastrointestinal bleeding. In this report, we present a case of young adult without history of gastrointestinal bleeding who had severe asymptomatic iron deficiency anemia, in which the evaluation of small bowel with capsule endoscopy and balloon-assisted enteroscopy allow us to diagnosis ulcerated Meckel diverticulum.