RESUMO
Percutaneous endoscopic gastrostomy (PEG) insertion is an effective endoscopic procedure for enteral feeding in patients with difficulty swallowing. Many postprocedural complications have been reported after the PEG procedure. The displacement of the transverse colon over the anterior gastric wall can predispose the patient to colonic injury and fistulae during PEG placement. Gastrocolonic fistulas represent a serious but rare complication post PEG placement. We report a 90 year old man with a background of multiple comorbidities and high preoperative risk who developed a gastrocolocutaneous fistula post PEG placement due to a colonic injury. He was successfully treated with nonoperative management.
RESUMO
RESUMEN La hemorragia talámica pertenece al grupo de las hemorragias intracerebrales de etiología no traumática o quirúrgica. Es una entidad relativamente infrecuente y tiene una prevalencia de 6-15 % de los casos dentro de dicho grupo. El tálamo es una estructura anatómica donde convergen múltiples vías neuronales, por lo tanto, sus manifestaciones clínicas no están totalmente descritas. A pesar de ello, se conoce que su presentación clínica más frecuente está asociada al síndrome sensitivo de Déjerine-Roussy, caracterizado por intenso dolor neuropático, alodinia contralateral a la lesión, hemiparesia y hemiataxia. La hemorragia talámica también se puede presentar con alteraciones de la memoria, sueño, emociones y procesamiento de información sensitiva. Se presenta un caso de hemorragia talámica izquierda espontánea en un paciente de 71 años que debutó con cambios en su comportamiento, bradipsiquia y amnesia anterógrada, con posterior recuperación completa de su estado cognitivo y psicológico antes de los 8 días y con hallazgos normales en la panangiografía.
ABSTRACT Thalamic hemorrhage belongs to the group of intracerebral hemorrhages of non-traumatic or surgical etiology. It is relatively rare and has a prevalence of 6-15% of cases. The thalamus is an anatomical structure where multiple neural pathways converge; therefore, its clinical manifestations are not fully described. Despite this, it is known that its most frequent clinical presentation is associated with the Dejerine-Roussy sensory syndrome, characterized by intense neuropathic pain, allodynia contralateral to the lesion, hemiparesis and hemiataxia. Thalamic hemorrhage can also present with alterations in memory, sleep, emotions, and the processing of sensitive information. We present a case of spontaneous left thalamic hemorrhage in a 71-year-old patient who presented with changes in his behavior, bradypsy-chia, and anterograde amnesia, with subsequent complete recovery of his cognitive and psychological state before 8 days and with normal findings in the panangiography.
