Incidental finding of intraductal papillary mucinous tumor with adenocarcinoma focus after variceal bleeding.

Case of a young female patient with reflux symptoms. During gastroscopy, the patient presented an episode of gastrointestinal bleeding after biopsy of a fundic lesion. Imaging tests were requested, showing a 8cm pancreatic cyst causing obstruction of the splenic vein with presence of portal hypertension and secondary gastric varices.

Hybrid-APC treatment for gastric vascular ectasia of atypical location after failed radiofrequency ablation.

A 76-year-old woman was being followed up for chronic anemia secondary to bleeding from vascular ectasias at the gastric antrum and the cardial and subcardial region. On several occasions the patient required fulguration of these lesions with conventional APC, which resulted in no clear improvement. Radiofrequency ablation of these lesions was then attempted using a 90-degree probe, which was successful on antral angiodysplasias but failed to remove lesions in the cardial and subcardial region since anatomy there prevented proper apposition of the probe onto the target mucosa. Given the absence of any improvement, it was decided to use fulguration for angiectasias at the cardial and subcardial level by means of Hybrid-APC, which consists of lifting the mucosa with an injection through the APC probe and then fulgurating in the pulsedAPC® mode, thus achieving a broader ablation area in a shorter time. During the subsequent review a clear reduction of vascular ectasias was observed.

Use of scopolamine butylbromide to facilitate specimen fixation after endoscopic submucosal dissection.

Endoscopic submucosal dissection (ESD) is a technique for the en bloc resection of early neoplastic lesions in the gastrointestinal tract. A step that must be carried out after excision is the pinning down of the specimen on a support plate such as a cork board to avoid artifacts because of tissue contraction. After ESD lesion borders usually curl up from contraction, hence this procedure must be carefully performed to prevent damaging the specimen. Recently, Nishizawa T, et al. reported that dropping adrenaline onto the lesion results in edge relaxation, which facilitates fixation. However, the use of other drugs-such as Buscapine-that induce gastrointestinal smooth muscle relaxation, potentially with similar effects, has not been described. Below, two ESD specimens from two different institutions are shown. These specimens correspond to gastric lesions. Buscapine is applied on their surface and the edges become relaxed, thus facilitating stretching and thus fixation. In conclusion, the use of Buscapine may help in the processing of excised lesions by facilitating pinning out and reducing damage risk for specimens.

Estudio de calidad de vida en pacientes asintomáticos con hepatitis C / No disponible

OBJETIVO Y MÉTODOS: estudio observacional, longitudinal, prospectivo en el que se evaluaron los cambios en la percepción de calidad de vida en pacientes asintomáticos con hepatitis C tratados con antivirales de acción directa. RESULTADOS: los cuestionarios SF-36 y EQ-5D-5L realizados sobre 86 pacientes tratados y 12 pacientes control demostraron mejoría de varios parámetros (función física, dolor corporal, salud general, vitalidad y función social), sobre todo cuando se compara la percepción antes del tratamiento y tras finalizar el seguimiento después de la curación. CONCLUSIÓN: estos datos apoyan la hipótesis de que el virus de la hepatitis C puede causar empeoramiento en la calidad de vida de los pacientes asintomáticos

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Quality of life study in asymptomatic patients with hepatitis C.

OBJECTIVE AND METHODS: an observational, longitudinal, prospective study was performed to assess changes in perceived quality of life in asymptomatic patients with hepatitis C under treatment with direct-acting antivirals. Questionnaires SF-36 and EQ-5D-5L were administered to 86 treated patients and 12 controls. RESULTS: there were improvements in several parameters such as physical functioning, bodily pain, general health, vitality and social functioning, particularly when the perceptions were compared before treatment and after treatment completion and following recovery. CONCLUSION: these data support the hypothesis that the hepatitis C virus may worsen quality of life in asymptomatic patients.

Hepatitis aguda como manifestación de sífilis secundaria / Acute hepatitis as a manifestation of secondary syphilis

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Multiseptate gallbladder: a rare ultrasonographic finding.

Multiseptate gallbladder is a congenital abnormality categorized as a gallbladder shape variant with some 20 cases reported thus far in the literature. Clinical presentation may be highly variable, ranging from asymptomatic to chronic pain in the right upper quadrant, cholecystitis, and even pancreatitis. It may be associated with other bile duct abnormalities such as choledochal cyst, ectopic gallbladder or anomalous biliopancreatic junction.

Vesícula biliar multiseptada. Un raro hallazgo ecográfico / Multiseptate gallbladder: a rare ultrasonographic finding

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A bronchobiliary fistula treated with cyanoacrylate glue in a patient with liver cirrhosis.

A 60-year-old male was operated upon in 2002 for liver hydatidosis, which included partial right hepatectomy with cholecystectomy and bilioduodenal anastomosis. He then developed liver cirrhosis secondary to left hepatic duct stricture. He presents at the emergency room with dry cough, which he had for a month and then became associated with yellowish, bitter-tasting "fluid" expectoration. A chest-abdominal CT scan revealed a 6 x 5-cm collection roughly located somewhere between the middle pulmonary lobe and subphrenic area . A fistula was suspected, which prompted a sputum biochemistry test that was positive for bilirubin. Given the patient's impaired liver function because of his liver disease conservative treatment was initiated with an inner-outer drain under transparietal hepatic cholangiography (TPHC) to promote bile outflow via the duodenum. Subsequently, TPHC was used to locate the point where contrast leaked from the biliary tree into a pleural cavity, and the fistula was sealed using cyanoacrylate glue, which resulted in improved symptomatology.

Fístula bilio-bronquial en un paciente con cirrosis hepática tratada mediante sellado con cianocrilato / A bronchobiliary fistula treated with cyanoacrylate glue in a patient with liver cirrhosis

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Perforación múltiple de divertículos de intestino delgado en paciente con síndrome de Ehlers-Danlos / Multiple perforation of small-intestine diverticula in a patient with Ehlers-Danlos syndrome

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Multiple perforation of small-intestine diverticula in a patient with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome represents a group of hereditary connective tissue disorders characterized by ligamentous hyperlaxity, fragile skin and joint hypermobility. Gastrointestinal complications in this syndrome are less well known.