Gastric leiomyoma as an atypical cause of upper gastrointestinal bleeding.

We introduce the case of a 40-year-old male with no medical history of interest who was admitted in the Digestive System unit due to upper gastrointestinal bleeding, and a large protruding lesion located in gastric antrum was detected during oral endoscopy, but biopsies were negative for malignancy. Therefore, endoscopic ultrasound was performed, confirming the submucosal origin of the lesion, puncturing it, and obtaining histological results compatible with leiomyoma. Gastric leiomyomas are rare mesenchymal tumors that are usually asymptomatic and are detected by performing a procedure for another reason. The definitive diagnosis is histological, being sometimes difficult to obtain samples given the submucosal origin of these lesions. The main treatment is surgery, although endoscopic resection is accepted in certain cases.

Band ligation-assisted endoscopic resection of a rectal Abrikossoff's tumor.

A 46-year-old man underwent colonoscopy due to familiar screening for colorectal cancer, revealing an 8-mm rounded lesion in the middle rectum, subepithelial in appearance, with non-specific characteristics. Biopsies were taken, which were inconclusive. The study was completed with a CT scan, which was normal. Given the characteristics of the lesion, smaller than one centimetre, with a low probability of muscle invasion and the possibility of complete resection, band-assisted endoscopic treatment was decided, without first carrying out an endosonographic study.

Severe drug esophagitis in a patient with achalasia.

An 82-year-old female with a history of osteoporosis and achalasia treated with periodic botulinum toxin injections presented a few weeks after the last session, reporting dysphagia and retrosternal pain. An upper gastrointestinal endoscopy revealed mucosal involvement in the middle and lower third of the esophagus in the form of edema, friability, exudate and extensive superficial ulcers, which converged distally and extended around the entire circumference. The cardia was punctiform, but could be passed without difficulty.

Caso de pancreatitis aguda tóxica por infusiones de cola de caballo / Case of drug-induced acute pancreatitis produced by horsetail infusions

Introducción: las causas más frecuentes de pancreatitis aguda son las litiasis biliares, el consumo de alcohol, el tabaquismo o los tumores. Hay un porcentaje de ellas que quedan sin causa establecida, catalogándose de pancreatitis idiopática. Caso clínico: presentamos el caso de una mujer de 56 años con antecedente de suprarrenalectomía bilateral de las glándulas suprarrenales en tratamiento hormonal sustitutivo con corticoides, que presenta episodios de pancreatitis aguda leve de repetición con estudio etiológico (analítico y pruebas de imagen) sin hallazgos. Se sospecha el origen tóxico, por lo que se retiran los corticoides y se modifica el tratamiento antihipertensivo, pero la clínica persiste. Posteriormente se detecta el consumo habitual de infusiones de cola de caballo. Tras su suspensión la paciente se queda asintomática y no vuelve a presentar nuevos episodios. Discusión: la pancreatitis aguda tóxica es una causa rara de pancreatitis que con cierta frecuencia queda sin diagnosticar por la dificultad de establecer una relación entre el agente tóxico y la pancreatitis. Los fármacos relacionados con las pancreatitis agudas son múltiples, mientras que la información disponible es escasa con los productos de herboristería. Se suelen presentar como episodios leves y recurrentes, sin objetivar la causa en el estudio tanto analítico como por pruebas complementarias (ecografía de abdomen, tomografía computarizada [TC] de abdomen, colangiopancreatografía por resonancia magnética [RMN] y ecoendoscopia). Es importante detectar el origen de estas pancreatitis para evitar su recurrencia (AU)

Introduction: The most frequent causes of acute pancreatitis are biliary stones, alcohol consumption, smoking and tumors. Some of them do not have any established cause, and they are catalogued as idiopathic pancreatitis. Case report: We report the case of a 56-year-old woman with a history of bilateral adrenalectomy on hormone replacement therapy with corticosteroids, who has recurrent episodes of mild acute pancreatitis with an etiologic study (laboratory and imaging tests) without significant findings. A drug-induced etiology was suspected, so corticosteroids were removed and antihypertensive treatment was modified, but the clinical manifestations persisted. Later regular consumption of horsetail infusions was detected, and after their suspension the patient became asymptomatic and has not presented new episodes. Discussion: The drug-induced acute pancreatitis is a strange cause of pancreatitis that is frequently underdiagnosed because of the difficulty to establish a relationship between the drugs and the pancreatitis. Lots of drugs have been related with acute pancreatitis, while the information available for herbal products is limited. They usually present like mild and recurrent episodes, without significant findings in both laboratory and imaging tests (abdominal ultrasound, abdominal computed tomography [CT], cholangiography and endoscopic ultrasound). It is important to detect the origin of this type of pancreatitis to prevent recurrence (AU)

Case of drug-induced acute pancreatitis produced by horsetail infusions.

INTRODUCTION: The most frequent causes of acute pancreatitis are biliary stones, alcohol consumption, smoking and tumors. Some of them do not have any established cause, and they are catalogued as idiopathic pancreatitis. CASE REPORT: We report the case of a 56-year-old woman with a history of bilateral adrenalectomy on hormone replacement therapy with corticosteroids, who has recurrent episodes of mild acute pancreatitis with an etiologic study (laboratory and imaging tests) without significant findings. A drug-induced etiology was suspected, so corticosteroids were removed and antihypertensive treatment was modified, but the clinical manifestations persisted. Later regular consumption of horsetail infusions was detected, and after their suspension the patient became asymptomatic and has not presented new episodes. DISCUSSION: The drug-induced acute pancreatitis is a strange cause of pancreatitis that is frequently underdiagnosed because of the difficulty to establish a relationship between the drugs and the pancreatitis. Lots of drugs have been related with acute pancreatitis, while the information available for herbal products is limited. They usually present like mild and recurrent episodes, without significant findings in both laboratory and imaging tests (abdominal ultrasound, abdominal computed tomography [CT], cholangiography and endoscopic ultrasound). It is important to detect the origin of this type of pancreatitis to prevent recurrence.