Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile.

BACKGROUND: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AIM: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. METHODS: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. RESULTS: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1-99.2), 82.2% (95%CI: 57.6-93.3), 40.0% (95%CI: 16.5-82.8) and 25.9% (95%CI: 4.5-55.7%), respectively. NET (HR 6.1; 95%CI: 2.1-17.2) and GIST (HR 24.4; 95%CI: 3.0-19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. CONCLUSIONS: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.

Clinical impact of capsule endoscopy on patients with suspected small bowel bleeding: Experience at a highly specialized hospital in Colombia.

INTRODUCTION AND AIMS: Capsule endoscopy is part of the diagnostic approach to patients with suspected small bowel bleeding and data on its clinical impact are still limited in developing countries. The primary aim of the present study was to determine its impact on subsequent diagnostic and therapeutic decisions. MATERIAL AND METHODS: A retrospective study was conducted that included all the patients that underwent capsule endoscopy with the PillCam™ SB 3 Capsule system due to suspected small bowel bleeding treated at the Hospital Universitario Fundación Valle del Lili between January 2011 and December 2020. RESULTS: A total of 158 patients met the inclusion criteria. Mean patient age was 63 years (interquartile range [IQR], 52-74), 53.6% of the patients were women, and high blood pressure was the most frequent comorbidity (43.7%). The main indication was overt bleeding (58.2%). Of all the capsule endoscopies carried out, 63.9% showed lesions that were potentially responsible for bleeding. Medical or surgical treatment was indicated in 63.3% of the case total. Rebleeding at 6 months occurred in 15 patients and there were 2 deaths due to gastrointestinal bleeding at 6 months. CONCLUSIONS: Capsule endoscopy has a high impact on patients with suspected small bowel bleeding, with respect to clinical decision-making, as well as rebleeding, hospitalization, and mortality outcomes. The positivity rate of lesions potentially responsible for bleeding was similar to that reported in developed countries.

Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso / Pneumoperitoneum secondary to massive intestinal pneumatosis: a case report

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis.

Introduction. Intestinal pneumatosis is defined as the presence of air cysts in the wall of the digestive tract at the submucosal or subserosal level, mainly compromising the small intestine. The clinical manifestations of the disease are nonspecific, and the imaging findings are essential in the diagnostic approach. Management can be conservative and/or surgical depending on the intestinal compromise and associated complications. Clinical case. The following is the case of a 78-year-old man, who was admitted due to chronic abdominal pain with imaging findings of pneumoperitoneum. Patient underwent surgery and a massive ileum pneumatosis was found, requiring intestinal resection. Results. The patient ́s postoperative course was uneventful, and he was discharged without further complications. Conclusions. Intestinal pneumatosis is an uncommon disease, which mostly affect men population. Clinical suspicion of this condition should be confirmed with abdominal tomography. Candidates for medical management are those with benign course pathologies without hemodynamic compromise and/or complications. Surgical management should be reserved for patients with acute abdomen or sepsis.

Rol de las imágenes en la evaluación de la invaginación intestinal del adulto: un estudio retrospectivo de 10 años / Role of imaging in the evaluation of intussusception in adults: a 10-year retrospective study

Introducción: La invaginación intestinal es la introducción de un segmento de asas intestinales en otro segmento adyacente. A diferencia de la población pediátrica, cuya etiología es principalmente idiopática, en el adulto se asocia con mayor frecuencia a patologías graves. El uso cada vez mayor de estudios imagenológicos en la evaluación abdominal ha llevado a mayor detección de invaginaciones intestinales sin enfermedad subyacente, en las que no es posible determinar una causa de base. El objetivo de este estudio fue revisar la presentación clínica, estudio y tratamiento en pacientes con diagnóstico imagenológico de invaginación intestinal en ecografía o tomografía computarizada de abdomen. Método: Se realizó un estudio descriptivo retrospectivo a partir de los informes radiológicos de ecografías y tomografías computarizadas de abdomen obtenidas en un periodo de 10 años en una institución hospitalaria. Resultados: Se obtuvieron 40 casos. En el 10% de ellos, la invaginación intestinal fue un hallazgo incidental en un estudio por otra causa. En el 68% de los casos no se identificó una causa subyacente, demostrándose resolución espontánea en el 75% de los casos con estudio posterior. El síntoma más frecuente fue el dolor abdominal, presente en el 60% de los pacientes. La ubicación más habitual fue entero-enteral en el 90% de los casos. Solo en el 8% de los casos la invaginación intestinal se atribuyó a una causa maligna. Hubo resolución quirúrgica en 7 pacientes. Conclusión: El aumento en el uso de imágenes para el estudio abdominal ha demostrado que existe un porcentaje importante de invaginaciones intestinales que son idiopáticas y que presentarán resolución espontánea.(AU)

Introduction: Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. Method: We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. Results: In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. Conclusion: The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.(AU)

Role of imaging in the evaluation of intussusception in adults: A 10-year retrospective study.

INTRODUCTION: Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception. METHOD: We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period. RESULTS: In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically. CONCLUSION: The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously.

Congenital Paraduodenal Hernia: A Case Report

Paraduodenal hernia is a rare congenital anomaly that arises from an alteration in the midgut rotation during embryogenesis. Consequently, the small intestine becomes trapped in a sac of the posterior mesentery of the colon. This entity can compromise the intestinal segment's viability and the patient's life. Its diagnosis is difficult, rarely suspected, and often confused with other causes of abdominal pain. We present the case of a 29-year-old male patient with a documented paraduodenal hernia during surgery, its correction, and follow-up, in which no complications were reported.

La hernia paraduodenal es una anomalía congénita poco frecuente que surge de una alteración en la rotación del intestino medio durante la embriogénesis. En consecuencia, el intestino delgado queda atrapado en un saco del mesenterio colónico posterior. Dicha entidad puede comprometer la viabilidad del segmento intestinal y la vida del paciente. Su diagnóstico es difícil, pocas veces sospechado y muchas veces confundido con otras causas de dolor abdominal. Presentamos el caso de un paciente de 29 años con una hernia paraduodenal documentada durante la cirugía, su corrección y seguimiento, en el cual no se documentaron complicaciones.

Melanoma metastásico en intestino delgado: causa infrecuente de perforación: reporte de caso / Metastatic melanoma in the small intestine: infrequent cause of perforation: case report / Melanoma metastático em intestino delgado: causa rara de perfuração: relato de caso

El intestino delgado es el sitio de asiento más frecuente del melanoma metastásico. Su diagnóstico es un desafío por cursar asintomático o con síntomas inespecíficos. Son pocos los casos que presentan complicaciones, siendo infrecuente la peritonitis por perforación. El objetivo del trabajo es comunicar el caso clínico de una peritonitis por perforación de una metástasis de melanoma en intestino delgado. Caso clínico: Paciente de sexo masculino de 66 años con diagnóstico de melanoma de cuello y secundario óseo, encefálico y pulmonar, fue intervenido de urgencia por peritonitis aguda por perforación de metástasis en intestino delgado. El estudio histológico confirmó secundarismo de melanoma cutáneo. Conclusión: Sabiendo que el yeyuno íleon es el sitio de asiento más frecuente de las metástasis de melanoma, ante la presencia de síntomas digestivos inespecíficos o anemia se debe sospechar su compromiso y evaluar posibles alternativas terapéuticas.

The small intestine is the most frequent site of metastatic melanoma. However, its diagnosis continues to be a challenge since it is usually asymptomatic or with non-specific symptoms. Few cases result in complications, peritonitis due to perforation being infrequent. The objective of the work is to report a clinical case of peritonitis due to perforation of a melanoma metastasis in the small intestine. Clinical case: A 66-year-old male patient diagnosed with melanoma of the neck and secondary bone, brain and lung melanoma, underwent emergency surgery for acute peritonitis due to perforation of metastasis in the small intestine, which was resected and anastomosed. The histology confirmed the secondary nature of the cutaneous melanoma. Conclusion: Knowing that the jejunum-ileum is the most frequent site of melanoma metastases, in the presence of non-specific digestive symptoms or anemia, its involvement should be suspected and possible therapeutic alternatives should be evaluated.

O intestino delgado é o local mais frequente de melanoma metastático. O diagnóstico é um desafio por ser assintomático ou apresentar sintomas inespecíficos. Há poucos casos que apresentam complicações, sendo pouco frequente a peritonite por perfuração. O objetivo deste trabalho é relatar um caso clínico de peritonite por perfuração de metástase de melanoma no intestino delgado. Caso clínico: Paciente do sexo masculino, 66 anos, diagnosticado com melanoma no pescoço com metástase óssea, cefálica e pulmonar. Foi submetido a cirurgia de emergência por peritonite aguda por perfuração de metástases do intestino delgado. O estudo histológico confirmou melanoma cutâneo. Conclusão: Sabendo que o jejuno e o íleo é o local mais frequente de metástase de melanoma, na presença de sintomas digestivos inespecíficos ou anemia deve-se suspeitar de seu acometimento e avaliar possíveis alternativas terapêuticas.

Efeitos de Bifidobacterium animalis subsp. Lactis HN019 vivo e inativado na periodontite experimental em ratos / Effects of Bifidobacterium animalis subsp. Lactis HN019 live and inactivated in experimental periodontitis in rats

A periodontite é uma doença crônica e complexa, abrangendo mais de uma forma de tratamento combinados. Os probióticos têm ganhado espaço em casos de terapias adjuvantes e mostrado resultados promissores quando utilizados em casos de periodontite. O objetivo do estudo foi avaliar a ação do probiótico Bifidobacterium lactis vivo e inativado na periodontite induzida por ligadura em ratos. Foram utilizados 32 ratos machos, nos seguintes grupos: GC/controle animais sem periodontite que receberam apenas caldo Man Rogosa-Sharpe (MRS); GP/periodontite experimental e caldo MRS; GP/PROB periodontite experimental + probiótico vivo e o grupo GP/POSB periodontite experimental + posbiótico. Após 45 dias, os animais foram eutanasiados. As hemimandíbulas foram analisadas por microtomografia computadorizada e histomorfometria de perda óssea alveolar. O intestino delgado foi analisado por histomorfometria de altura de vilos e profundidade de criptas intestinais. Os dados foram submetidos à análise estatística apropriada, ao nível de 5%. Os parâmetros de volume ósseo (BV/TV), número de trabéculas (Tb.N), separação das trabéculas (Tb.Sp) e porosidade total (PO total) foram diferentes entre o GC e os demais grupos, GP, GP/POSB e GP/PROB. O GC apresentou maiores valores para BV/TV. Para PO total e Tb.Sp o GC apresentou menores valores. No parâmetro de Tb.n o GP.PROB apresentou maiores valores. Para espessura trabecular (Tb.Th) houve diferença estatística entre o GC e GP e entre GC e GP/PROB, sendo que GC apresentou valores maiores em ambos os casos. Para a perda óssea da furca houve diferença estatística entre o GC e os demais grupos, sendo que GC apresentou menores valores de perda óssea. Em relação ao intestino delgado, não houve diferença estatística entre os grupos. Concluímos que tanto o probiótico vivo como o inativado não foram capazes de atuar na inibição da perda óssea na área de furca bem como não foram capazes de agir como modulador da resposta inflamatória no intestino (AU)

Periodontitis is a chronic and complex disease, encompassing more than one form of combined treatment. Probiotics have gained space in cases of adjuvant therapies and have shown promising results when used in cases of periodontitis. The aim of the study was to evaluate the action of the live and inactivated probiotic Bifidobacterium lactis on ligature-induced periodontitis in rats. 32 male rats were used in the following groups: CG/control animals without periodontitis that received only Man Rogosa-Sharpe broth (MRS); GP/experimental periodontitis and MRS broth; GP/PROB experimental periodontitis + live probiotic and GP/POSB experimental periodontitis + postbiotic group. After 45 days, the animals were euthanized. The hemimandibles were analyzed by computed microtomography and histomorphometry of alveolar bone loss. The small intestine was analyzed by histomorphometry of villus height and intestinal crypt depth. Data were subjected to appropriate statistical analysis at the 5% level. The parameters of bone volume (BV/TV), number of trabeculae (Tb.N), trabeculae separation (Tb.Sp) and total porosity (total PO) were different between the CG and the other groups, GP, GP/POSB and GP/PROB. The CG showed higher values for BV/TV. For total PO and Tb.Sp, the CG showed lower values. In the Tb.n parameter, GP.PROB presented higher values. For trabecular thickness (Tb.Th) there was a statistical difference between GC and GP and between GC and GP/PROB, with GC showing higher values in both cases. For bone loss in the furcation, there was a statistical difference between the CG and the other groups, with the CG having lower values of bone loss. Regarding the small intestine, there was no statistical difference between the groups. We conclude that both the live and inactivated probiotics were not able to inhibit bone loss in the furcation area, nor were they able to act as a modulator of the inflammatory response in the intestine (AU).

Linfangiectasia intestinal primaria: una enfermedad rara como causa de enteropatía pierde-proteínas / Primary intestinal lymphangiectasia: a rare disease as a cause of protein-losing enteropathy

La linfangiectasia intestinal primaria es un trastorno raro asociado a una enteropatía pierde-proteínas. Las principales manifestaciones son las derivadas de la hipoalbuminemia. Para lograr el diagnóstico se necesita la imagen endoscópica típica de la linfangiectasia intestinal y el aumento de las cifras de alfa-1-antitripsina en las heces de 24 horas. El tratamiento es básicamente dietético. (AU)

Morphological investigation of protective effects of CDP-choline on liver and small intestine in an experimental sepsis model in rats / Investigación morfológica de los efectos protectores de la CDP-colina en el hígado y el intestino delgado en un modelo experimental de sepsis en ratas

SUMMARY: Fifty male Wistar albino rats were divided into 5 groups; Group 1 as a sham group. Group 2 as a control group, Group 3 as 100 mg/kg CDP-choline administered group, Group as 200 mg/kg CDP-choline administered group, and Group 5 as sepsis group. The sepsis model was performed by ligating and perforating the caecum of rats. Liver and small intestine tissues were assessed either histologically or quantitatively and qualitatively. There was a significant difference between the sepsis and CDP-choline groups for liver and intestinal damage evaluated in tissue samples. (p <0.001). CDP-choline treatment partially improved dose-dependent the clinical parameters of sepsis and septic shock, reversed micro-anatomical damage caused by sepsis.

Cincuenta ratas albinas Wistar macho se dividieron en 5 grupos; Grupo 1 como grupo control simulador, el grupo 2 como grupo de control, el grupo 3 como grupo al que se administró 100 mg/kg de CDP-colina, el grupo 4 como grupo al que se administró 200 mg/kg de CDP-colina y el grupo 5 como grupo con sepsis. El modelo de sepsis se realizó ligando y perforando el intestino ciego de las ratas. Los tejidos del hígado y del intestino delgado se evaluaron histológicamente o cuantitativa y cualitativamente. Hubo una diferencia significativa entre los grupos de sepsis y CDP-colina para el daño hepático e intestinal evaluado en muestras de tejido (p<0,001). El tratamiento con CDP-colina mejoró parcialmente, según la dosis, los parámetros clínicos de sepsis y shock séptico y revirtió el daño micro anatómico causado por la sepsis.

Liposarcoma pleomórfico originado en una localización inusual. Presentación de caso / Pleomorphic liposarcoma arising in an unusual site. A case report

Los liposarcomas son el grupo más común de las neoplasias mesenquimatosas malignas. Suelen aparecer en las extremidades y en el retroperitoneo. Es excepcional su localización intestinal. Se presenta el caso de un varón de 75 años que fue hospitalizado por anemia severa, en cuya TC se objetivó un engrosamiento de asa yeyunal de 5cm sospechoso de neoplasia. Se realizó resección parcial de intestino delgado. Macroscópicamente se identificó una tumoración polipoide ulcerada de 12×6cm. Microscópicamente se observó una neoplasia bien delimitada, ulcerada, de transición abrupta con una mucosa circundante normal, compuesta por lipoblastos pleomórficos sobre un fondo sarcomatoso. Existen muy pocos casos publicados de liposarcomas intestinales, la mayoría de los cuales eran liposarcomas bien diferenciados o desdiferenciados. Se presenta el caso de un liposarcoma pleomórfico de intestino delgado por su excepcional localización y la importancia en su diagnóstico diferencial.(AU)

Liposarcomas are the most common group of malignant mesenchymal neoplasms. They usually occur in the extremities and the retroperitoneum and only rarely in the intestine. We report the case of a 75-year-old man presenting with severe anaemia. A CAT scan revealed a 5cm thickening of the jejunal loop, arousing the suspicion of a neoplasm. A partial resection of the small intestine was performed. Macroscopy showed a 12×6cm ulcerated, polypoid mass. Microscopically, a well circumscribed, ulcerated tumour was seen, which had well-defined margins with the surrounding normal mucosa. It consisted of pleomorphic lipoblasts within a sarcomatous background. Very few cases of intestinal liposarcomas have been published and the majority report well-differentiated or undifferentiated liposarcomas. We present a case of a pleomorphic liposarcoma of the small intestine, which is an unusual location and emphases the importance of a comprehensive differential diagnosis.(AU)

[Pleomorphic liposarcoma arising in an unusual site. A case report]. / Liposarcoma pleomórfico originado en una localización inusual. Presentación de caso.

Liposarcomas are the most common group of malignant mesenchymal neoplasms. They usually occur in the extremities and the retroperitoneum and only rarely in the intestine. We report the case of a 75-year-old man presenting with severe anaemia. A CAT scan revealed a 5cm thickening of the jejunal loop, arousing the suspicion of a neoplasm. A partial resection of the small intestine was performed. Macroscopy showed a 12×6cm ulcerated, polypoid mass. Microscopically, a well circumscribed, ulcerated tumour was seen, which had well-defined margins with the surrounding normal mucosa. It consisted of pleomorphic lipoblasts within a sarcomatous background. Very few cases of intestinal liposarcomas have been published and the majority report well-differentiated or undifferentiated liposarcomas. We present a case of a pleomorphic liposarcoma of the small intestine, which is an unusual location and emphases the importance of a comprehensive differential diagnosis.

Vasculitis intestinal y hallazgos en la videocápsula endoscópica: reporte de caso y revisión de la literatura / Intestinal Vasculitis and Endoscopic Video Capsule Findings: Case Report and Literature Review

Resumen Las vasculitis sistémicas pueden llegar a afectar los vasos sanguíneos de todos los tamaños, provocando necrosis e inflamación. La granulomatosis con poliangitis (GPA) es una vasculitis de vasos pequeños y medianos. Las presentaciones clínicas pueden ser locales o difusas en el tracto gastrointestinal. Presentamos el caso de un paciente con diagnóstico de vasculitis sistémica asociada a anticuerpos anticitoplasma (ANCA) mieloperoxidasa (MPO) (poliangitis microscópica) confirmada con biopsia renal, con clínica de 15 días consistente en astenia, adinamia, oliguria subjetiva, edema de miembros superiores e inferiores, hiporexia y melenas. En el examen físico, el tacto rectal fue positivo para melenas, posteriormente presentó anemización secundaria a melenas, por lo que se realizó videocápsula endoscópica en la que se evidenciaron hallazgos compatibles con vasculitis entérica. Durante su estancia presentó compromiso multisistémico dado por la afectación renal, pulmonar, neurológica y gastrointestinal, manejada en la unidad de cuidados intensivos (UCI), donde se iniciaron pulsos de esteroide sistémico y hemodiálisis. Conclusión: la vasculitis gastrointestinal es una complicación rara; sin embargo, ocurre y causa una grave amenaza para la vida de los pacientes. El diagnóstico diferencial debe cubrir otras enfermedades inflamatorias, especialmente la enfermedad de Crohn. Su adecuado reconocimiento influencia de forma significativa el pronóstico, pues el inicio rápido de la terapia con esteroides puede cambiar el curso de la enfermedad.

Abstract Systemic vasculitis can affect blood vessels of all sizes, causing necrosis and inflammation. Granulomatosis with polyangiitis (GPA) is a vasculitis of small and medium blood vessels. Clinical manifestations may be local or diffuse in the gastrointestinal tract. We present a patient's case with systemic vasculitis associated with anti-cytoplasmic antibodies (ANCA), myeloperoxidase (MPO) antibodies (microscopic polyangiitis) confirmed through renal biopsy, presenting a 15-day clinical picture consisting of asthenia, adynamia, subjective oliguria, edema of the upper and lower limbs, hyporexia, and melena. The digital rectal examination was positive for melena in the physical examination, later presenting melena with secondary anemization. An endoscopic video capsule was performed, showing findings compatible with enteric vasculitis. During his stay, he presented multisystemic involvement due to renal, pulmonary, neurological, and gastrointestinal involvement, managed in the intensive care unit (ICU), where systemic steroid pulses and hemodialysis started. Conclusion: although gastrointestinal vasculitis is a rare complication, it occurs and threats patients' lives. Differential diagnosis should cover other inflammatory diseases, especially Crohn's disease. Gastrointestinal vasculitis early diagnosis significantly influences prognosis, as prompt steroid therapy can change the course of the disease.

Diverticulosis de intestino delgado, hallazgo intraoperatorio / Diverticulosis of the small bowell, intraoperative finding / Diverticulose do intestino delgado, achado intraoperatório

La diverticulosis puede presentarse en cualquier sector del tubo digestivo. La topografía de intestino delgado es infrecuente, se presenta sobre todo a nivel del yeyuno y en un 35% de los casos se asocia con diverticulosis colónica. Es más frecuente en mayores de 40 años. Los divertículos van disminuyendo de tamaño y número hacia el sector distal. Habitualmente el diagnóstico es incidental, sin embargo, pueden presentar complicaciones de las cuales se destacan por frecuencia el sangrado gastrointestinal y la diverticulitis. Se plantea que la deficiencia de fibra dietética generaría anomalías en el peristaltismo intestinal, lo que junto con fenómenos pseudo-obstructivos y alta presión intraluminal, actuaría en áreas de debilidad focal provocando la lesión. Presentamos el caso de una paciente de 88 años con una oclusión de colon a la cual se le realizó una cirugía de Hartmann, en el intraoperatorio se identificó divertículos de yeyuno sin elementos complicaciones.

Chromogranin A (CgA) as a biomarker in carcinoid heart disease and NETG1/G2 neuroendocrine neoplasms of the small intestine (SI-NENs) related carcinoid syndrome

IntroductionProgression of carcinoid syndrome (CS) to carcinoid heart disease (CHD) is difficult to predict. This retrospective analysis evaluates the use of chromogranin A (CgA), a biomarker widely used in the diagnosis of neuroendocrine tumours (NET), in monitoring CS and disease progression.Patients and methods108 patients with confirmed CS, selected from a group of 351 patients with neuroendocrine neoplasms of the small intestine (SI-NENs), including NETG1 well 40% and NETG2 60% moderately differentiated NET. CgA concentration was measured during initial diagnosis and clinical follow up in 84 patients, 27 of them subsequently developed CHD. The patient's overall survival (OS) was evaluated using the Kaplan-Meier method.ResultsPatients with CHD, were found to have significantly shorter OS than patients with CS but without CHD (67.22 vs. 73.03 months). Univariate and multivariate analyses revealed that initial high concentration of CgA and/or increased concentration of CgA is significantly associated with decreased median OS in patients with CS (p<0.05).ConclusionCgA has potential as a clinically useful biomarker in reporting disease status and predicting outcome in patients with CS and with CHD. (AU)

IntroducciónLa progresión hacia la afectación cardiaca en el síndrome carcinoide (SC) es difícil de predecir. En el presente análisis retrospectivo se evaluó el uso de la cromogranina A (CgA), un biomarcador ampliamente utilizado en el diagnóstico de los tumores neuroendocrinos (TNE), en el seguimiento del SC y en la progresión de la enfermedad.Pacientes y métodosSe incluyeron 108 pacientes con SC confirmado, seleccionados de un grupo de 351 pacientes con tumores neuroendocrinos del intestino delgado (TNE-ID). El 40% de pacientes tenían un TNE G1 bien diferenciado y un 60% un TNE G2 moderadamente diferenciado. Los niveles de CgA se determinaron en el momento del diagnóstico y durante el seguimiento en 84 pacientes, 27 de los cuales desarrollaron afectación cardiaca. La supervivencia global de los pacientes se evaluó mediante el método de Kaplan-Meier.ResultadosLos pacientes con afectación cardiaca tuvieron una supervivencia global significativamente más corta que aquellos sin ella (67,22 frente a 73,03 meses). El análisis univariado y multivariado mostró que los niveles inicialmente altos de CgA y/o los niveles elevados de CgA durante la evolución se asocian de forma significativa con una menor supervivencia global en los pacientes con SC (p<0,05).ConclusiónLa CgA constituye un biomarcador clínicamente útil para evaluar la progresión de la enfermedad y la afectación cardiaca en pacientes con SC. (AU)

Efficacy of octreotide in bleeding recurrence from small bowel angioectasia: A comparative study.

INTRODUCTION: Fifty percent of small bowel bleeding is caused by angioectasia and the rebleeding rate due to small bowel angioectasia (SBA) is 80%. Its endoscopic treatment is difficult. Beneficial effects of octreotide on gastrointestinal angioectasia have been described, but no studies have reported its efficacy in SBA. AIM: Our aim was to investigate the effectiveness of octreotide in the prevention of rebleeding due to SBA. MATERIAL AND METHODS: Sixteen patients with bleeding caused by SBA were assigned to treatment with octreotide 100 µg/24 h SC, for at least 6 months, and compared with a non-treatment group of 36 patients. The primary outcome was the rebleeding rate, and the secondary outcomes were the number of hospital readmissions, bleeding-related death, and adverse effects. RESULTS: Octreotide was administered for 10.5 ± 8.4 months. Follow-up was 12.9 ± 17.3 months and 15.3 ± 17.7 months, in the treatment and non-treatment groups, respectively (p = 0.09). At the end of follow-up, 4 (25%) treatment group patients and 26 (72.2%) non-treatment group patients presented with rebleeding (p = 0.002). In the treatment group and non-treatment group, the cumulative probability of remaining rebleeding-free at one year was 79% vs 44.2%, and 79% vs 34.6% at 2 years, respectively (p = 0.05). Through the multiple logistic regression analysis, treatment was the protective variable. Six patients presented with adverse events. One of those patients (6.25%) had a major adverse event. CONCLUSIONS: Our results suggest that treatment with octreotide could be efficacious in the prevention of rebleeding due to SBA.