Retención de cápsula endoscópica en divertículo de Zenker

Caso clínico de paciente con cápsula endoscápica retenida en divertículo de Zenker, recuperada 2 años después de que se sometió al estudio. (AU)

Epilepsia refleja por agua caliente. Estrategias de diagnóstico y tratamiento / Hot water reflex epilepsy. Management and treatment

Las epilepsias reflejas son un grupo de trastornos epilépticos desencadenados por determinados estímulos (luces, agua caliente, música…). Por la semiología de los episodios pueden confundirse con algunos trastornos paroxísticos no epilépticos comunes como los síncopes. Es importante en la anamnesis dirigida preguntar acerca del estímulo desencadenante y de la cronología de la resolución del mismo para poder distinguirlos (AU)

Reflex epilepsies are a group of diseases induced by identifiable stimuli (light flashes, hot water, music…). They can be confused with non-epileptic paroxysmal events like syncope. It is important to ask about the identifiable trigger and about how the event is resolved to make a right differential diagnosis. (AU)

Apoptotic colopathy as a manifestation of Good's syndrome.

The case was a 44-year-old patient with four years of evolution of respiratory infections, fever, weight loss of 30 kg and chronic diarrhea with inconclusive colonoscopy studies, managed as inflammatory bowel disease (IBD), with a history of thymomectomy four years previously. On physical examination, there was severe protein-calorie malnutrition, skin lesions compatible with herpes simplex infection and lower limb edema. Blood tests were requested when pancytopenia and hypoalbuminemia were negative for human immunodeficiency virus (HIV). Chest tomography showed a budding tree pattern and bronchiectasis, but SARS-CoV-2 was negative. A colonoscopy was performed, showing the presence of ulcers in the sigmoid colon with an infectious aspect vs IBD.

Hereditary hemorrhagic telangiectasia diagnosed by enteroscopy: a case report.

Hereditary hemorrhagic telangiectasia (HHT) is a very rare autosomal dominant multisystemic disease. Patients with this disease usually present with punctate mucocutaneous telangiectasias and arteriovenous malformations. The diagnostic criteria currently in use are the Curaçao criteria. HHT is considered a clinical diagnosis; thus, no imaging or preclinical laboratory is mandatory, and diagnosis and management are performed according to the experience of the treating team. We herein describe a 58-year-old man with no significant medical history who presented with a 15-day history of intermittent hematochezia. He was admitted to the hospital and underwent a series of laboratory tests, including colonoscopy, which showed normal results. Therefore, the patient was discharged with a diagnosis of gastrointestinal bleeding. During his second visit to the emergency room, the doctors requested video capsule endoscopy because of the patient's history, and a diagnosis of HHT was made. The entire approach and treatment were completed with antegrade double-balloon enteroscopy. This case highlights the importance of endoscopic methods for timely diagnosis and proper management.

Movimientos oculares anormales en el lactante, la importancia de un adecuado diagnóstico diferencial / The importance of an adequate differential diagnosis: abnormal eye movements amongst infants

Los trastornos paroxísticos no epilépticos se definen como un conjunto de episodios, de aparición brusca, breves y generalmente recurrentes, cuyo mecanismo fisiopatológico consiste en una disfunción cerebral de diverso origen (hipóxico, psicológico…), no epiléptico. Son muy frecuentes en los lactantes debido a la inmadurez del sistema nervioso central, pudiendo confundirse con verdaderas crisis epilépticas. El conocimiento de estos y la realización de un adecuado diagnóstico diferencial es importante en el manejo de estos pacientes (AU)

Non-epileptic paroxysmal events are defined as a group of disorders characterized by sudden movements, in a short period of time, secondary to an abnormal loss of cerebral function (by hypoxia, psychiatric problems…), non-epileptic. They are very common in infants due to the immaturity of the central nervous system; so they can simulate seizures. It is extremely important for their management to know them and to make a correct differential diagnosis. (AU)

Manejo del síndrome de obstrucción intestinal distal por enteroscopia en un paciente postrasplante pulmonar / No disponible

No disponible

Trastorno de conducta en el niño: en ocasiones se esconde algo más / Conduct disorder in child, sometimes something may be hidden

La epilepsia focal del lóbulo temporal se presenta en la edad pediátrica con manifestaciones clínicas heterogéneas, incluyéndose entre ellas las alteraciones sensoperceptivas y los trastornos de la conducta, pudiendo llegar a ser manejados inicialmente como pacientes psiquiátricos, lo que retrasa el diagnóstico y el inicio del tratamiento

Temporal lobe epilepsy in childhood may present with a wide spectrum of symptoms, including behavioral changes and sensory symptoms. This situation can seem like a psychiatric pathology and can delay the diagnosis and initiation of treatment

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura / Management of a Bleeding Ulcer by Post-esophageal Ligation of Varices with Self Expanding metal Stents: Case Report and Literature Review

Los inicios del manejo del sangrado variceal con compresión directa datan de 1930 por Westphal y colaboradores. Después, en 1950, se desarrolló el balón de Sengstaken-Blakemore, definido por Panes y colaboradores como la primera línea de terapia; en 1980, a nivel de várices esofágicas y en várices gástricas, se empleaba el balón de Linton-Nachlass (1, 2). Se presenta el caso clínico de un paciente con cirrosis hepática por hepatitis C, Child B, con várices esofágicas, a las cuales se les realizó ligadura en dos ocasiones por sangrado y en la segunda ocasión por inminencia de ruptura, esta última llevada a cabo dos semanas antes del evento. El paciente muestra un cuadro clínico compatible con hemorragia de vías digestivas altas masiva, con evidencia endoscópica de úlcera esofágica sangrante que no mejora con terlipresina, ni escleroterapia con adrenalina, ni compresión local con balón de acalasia. En consecuencia, como terapia de rescate se decide colocar un stent esofágico metálico autoexpandible parcialmente recubierto (por no contar con totalmente recubierto en el momento), con control parcial del sangrado. Es recomendable el uso del stent como terapia de rescate para el sangrado por várices esofágicas refractarias. Debe emplearse el diseñado especialmente para esta indicación (SX-Ella Danis), como un puente para poder estabilizar al paciente y realizar una terapia definitiva como la TIPS, tal cual como se procedió en un nuestro paciente.

Early treatment of bleeding varices with direct compression dates from the work by Westphal et al. in 1930. Later in 1950, Sengstaken-Blakemore developed their balloon which Panes and collaborators defined as the first line of therapy for esophageal varices in 1980 while they used the Linton-Nachlass balloon for gastric varices (1, 2). This study presents the clinical case of a patient with liver cirrhosis due to hepatitis C, (Child B) with esophageal varices which were ligated on two different occasions because of bleeding. On the second occasion a rupture was imminent and ligation occurred two weeks prior to the event. The patient presented a clinical picture compatible with massive upper gastrointestinal bleeding with endoscopic evidence of a bleeding esophageal ulcer that did not improve with terlipressin, sclerotherapy with adrenaline, or balloon dilatation. Consequently, it was to use a partially covered self-expanding metal esophageal stent for salvage therapy since a completely covered stent was not available at that time. Stenting achieved partial control of bleeding. We recommend the use of stenting with a stent specifically designed for this indication (SX-Ella Danis) as salvage therapy for refractory bleeding from esophageal varices. The stent can be used as a bridge to stabilize the patient in order to perform TIPS as the definitive treatment, as in the case of our patient.