Recompensation of complications in patients with hepatitis B virus-related decompensated cirrhosis treated with entecavir antiviral therapy / 中华肝脏病杂志

Objective: To analyze the occurrence of recompensation conditions in patients with chronic hepatitis B virus-related decompensated cirrhosis after entecavir antiviral therapy. Methods: Patients with hepatitis B virus-related decompensated cirrhosis with ascites as the initial manifestation were prospectively enrolled. Patients who received entecavir treatment for 120 weeks and were followed up every 24 weeks (including clinical endpoint events, hematological and imaging indicators, and others) were calculated for recompensation rates according to the Baveno VII criteria. Measurement data were compared using the Student t-test or Mann-Whitney U test between groups. Categorical data were compared by the χ (2) test or Fisher's exact probability method between groups. Results: 283 of the 320 enrolled cases completed the 120-week follow-up, and 92.2% (261/283) achieved a virological response (HBV DNA 20 IU/ml). Child-Pugh and MELD scores were significantly improved after treatment (8.33 ± 1.90 vs. 5.77 ± 1.37, t = 12.70, P < 0.001; 13.37 ± 4.44 vs. 10.45 ± 4.58, t = 5.963, P < 0.001). During the 120-week follow-up period, 14 cases died, two received liver transplants, 19 developed hepatocellular cancer, 11 developed gastroesophageal variceal bleeding, and four developed hepatic encephalopathy. 60.4% (171/283) (no decompensation events occurred for 12 months) and 56.2% (159/283) (no decompensation events occurred for 12 months and improved liver function) of the patients had achieved clinical recompensation within 120 weeks. Patients with baseline MELD scores > 15 after active antiviral therapy achieved higher recompensation than patients with baseline MELD scores ≤15 [50/74 (67.6%) vs. 109/209 (52.2%), χ (2) = 5.275, P = 0.029]. Conclusion: Antiviral therapy can significantly improve the prognosis of patients with hepatitis B virus-related decompensated cirrhosis. The majority of patients (56.2%) had achieved recompensation. Patients with severe disease did not have a lower probability of recompensation at baseline than other patients.

Tratamiento con tocilizumab en amiloidosis AA: informe de casos y revisión de la literatura / Tocilizumab treatment in aa amyloidosis: case report and literature review

Introducción: la amiloidosis AA puede ser una complicación de ciertos trastornos inflamatorios crónicos, aunque entre el 21% y 50% puede ser idiopática. No existe un tratamiento específico. El tocilizumab, dirigido contra el receptor de IL-6 y orientado a disminuir la producción de SAA, podría ser eficaz. Métodos: en este estudio informamos datos de 6 pacientes con amiloidosis AA tratados con tocilizumab monoterapia subcutáneo en el período 2011-2018. Los criterios de valoración principales fueron la mejora clínica y bioquímica de los órganos afectados y los parámetros bioquímicos marcadores de inflamación. Resultados: el riñón estaba afectado en todos los pacientes, manifestándose con caída del filtrado glomerular y síndrome nefrótico. La hemorragia digestiva se presentó en un paciente y otro tenía afectación pulmonar en la biopsia. Luego del posterior al tratamiento, todos mejoraron el hematocrito, la albúmina sérica y el índice de masa corporal. El SAA disminuyó en 5 pacientes. Un paciente mejoró su función renal, mientras 4 se mantuvieron estables. Tres pacientes disminuyeron los valores de proteinuria. Conclusión: el tratamiento con tocilizumab podría ser eficaz en el tratamiento de los pacientes con amiloidosis AA. (AU)

Introduction: AA amyloidosis can be a complication of certain chronic inflammatory disorders, although between 21% and 50% can be idiopathic. There is no specific treatment. Tocilizumab, directed against the IL-6 receptor and aimed at decreasing SAA production, could be effective. Methods: in this study, we report data from 6 patients with AA amyloidosis treated with subcutaneous tocilizumab monotherapy between the period 2011-2018. The main endpoints were the clinical and biochemical improvement of the affected organs and the biochemical parameters markers of inflammation. Results: the kidney was affected in all patients, manifesting with a fall in glomerular filtration rate and nephrotic syndrome. Gastrointestinal bleeding occurred in one patient and another had lung involvement on biopsy. After treatment, all improved hematocrit, serum albumin, and body mass index. SAA decreased in 5 patients. One patient improved his kidney function, while 4 remained stable. Three patients decreased proteinuria values. Conclusion: treatment with tocilizumab could be effective in the treatment of patients with AA amyloidosis. (AU)

GIST duodenal asociado a hemorragia digestiva alta: reporte de caso / Duodenal GIST associated with upper gastrointestinal bleeding: case report

Resumen Introducción Los tumores del estroma gastrointestinal (GIST) corresponden al 1% de todas las neoplasias gastrointestinales, sin embargo, sólo el 3-5% de estos se desarrollan en el duodeno. Objetivo Reportar el caso de un paciente masculino con localización atípica de un tumor de estroma gastrointestinal y su manejo. Caso clínico paciente masculino de 50 años con antecedente de traumatismo encefalo craneano (TEC) con daño orgánico cerebral secundario, tabaquismo, consumidor de alcohol ocasional y sometido a quistectomía branquial en la infancia, que consulta en el servicio de urgencias por cuadro de hemorragia digestiva alta con compromiso hemodinámico. Tras realizar endoscopia digestiva alta (EDA), resonancia nuclear magnética (RNM) y tomografía computada (TC) de abdomen, se pesquisa masa tumoral en segunda porción de duodenal. Discusión A pesar de que la presentación clínica de los GIST es variable, lo más frecuente es que sean pacientes asintomáticos. En algunas ocasiones, al igual que en este reporte, pueden presentarse con dolor abdominal y/o hemorragia digestiva alta. El diagnóstico preoperatorio fue difícil ya que el estudio con imágenes (TC, RNM, EDA) sólo permite establecer la sospecha; el diagnóstico definitivo se realizó con biopsia (no contamos con endosonografía en nuestro centro). Debido a los sitios de reparo anatómico, no existe una cirugía estandarizada; en este caso, debido a la localización, infiltración y características, se decidió realizar una pancreatoduodenectomía.

Introduction Gastrointestinal stromal tumors (GIST), corresponds to 1%, of all gastrointestinal neoplasms, however, only 3%-5% developed in duodenum. Aim To report a case of a male patient with atypical location of gastrointestinal stroma tumor and the treatment proposed. Case report 50-year-old male patient, with medical history of organic brain damage secondary a traumatic brain injury, smoker, occasional alcohol consumer and branquial cystomy during childhood. Consulted in the emergency department for a high digestive hemorrhage case with hemodynamic compromise. Upper digestive endoscopy, computed tomography and nuclear magnetic resonance were performed, which impresses tumor-like lesion in the second duodenal portion. Discussion Although the GIST clinical presentation is variable, most often they are asymptomatic patients. In some times, as in this report, they may present with abdominal pain and/or upper gastrointestinal bleeding. The preoperative diagnosis was difficult, because the imaging study (CT, RNM, EDA) only stablished the suspicion and the final diagnosis was made by biopsy (we don't have endosonography in our center). Due to the anatomic repair, there is not a standardized surgery, in this case, due tumor location, infiltration and characteristics, it was decided to perform a pancreatoduodenectomy.

Primary aortoduodenal fistula: a rare cause of massive gastrointestinal hemorrhage

Aortoduodenal fistula (ADF) is the most common type of aortoenteric fistula (AEF). This is a rare entity, which produces communication between an abdominal aortic aneurysm (AAA) and the gastrointestinal tract (GIT), resulting in massive gastrointestinal bleeding. AEF/ADF is difficult to recognize clinically, with the classical triad of symptoms including a pulsating, palpable mass, abdominal pain, and GIT bleeding. AEF/ADF can be classified into primary when a communication between an AAA and the GIT develops with no history of prior aortic reconstructive surgery, and secondary, where the communication is on the background of previous aortic reconstructive surgery. Herein we present a case report of a 75-year-old Caucasian male patient with a clinical history of AAA, who presented with massive GIT bleeding and expired shortly after. An autopsy revealed communication between an atherosclerotic AAA and the lower third of the duodenum.

Utilidad de la escala de Glasgow-Blatchford en pacientes con hemorragia digestiva alta no variceal, con alto y bajo riesgo de complicaciones atendidos en el Servicio de Urgencias del Hospital Santo Tomas, 2015-2016 / Glasgow-Blatchford usefulness in patients with non variceal upper gastrointestinal bleeding with low and high risk of complications seen at the Emergency Department of Santo Tomas Hospital, 2015-2016

Introducción: La escala de Glasgow-Blatchford (GBS) nos permite clasificar al paciente como riesgo alto o bajo de presentar complicaciones. En los pacientes identificados como "bajo riesgo", la realización de una endoscopia temprana, podría disminuir los días intrahospitalarios y en el coste global. En nuestro medio, desconocemos la utilidad de la escala de GBS. Objetivo: Describir la utilidad de la escala de Glasgow-Blatchford (GBS) en la estratificación del riesgo en los pacientes con hemorragia digestiva alta (HDA) no variceal atendidos en el servicio de urgencias en un hospital de tercer nivel. Materiales y métodos: Se incluyeron prospectivamente 218 pacientes, y se les realizó en las primeras 24-48 h endoscopia urgente. Éstos se estratificaron, según la escala de GBS, en bajo riesgo (GBS ≤ 2), y alto riesgo (GBS ≥ 3). Se calculó la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de la escala de GBS en nuestro medio basándonos en el requerimiento de tratamiento endoscópico, radiológico (embolización arterial), transfusión de hemoderivados y/o cirugía, como estándar de oro para clasificar a los pacientes en alto riesgo. Resultados: Se incluyó un total de 218 pacientes, con edad media de 56 ± 18 años, de los cuales 121/218 (55%) fueron varones. 156/218 precisaron intervención por lo que fueron clasificados como "alto riesgo" mientras 62/218 no precisaron y se clasificaron como "bajo riesgo". Un valor de corte de GBS ≤ 2 mostró una sensibilidad del 98% con un VPN de 100%. La utilidad de la escala de GBS mostró un área bajo la curva ROC 0,83 (IC 95% 0,75-0,90). Conclusión: La escala de GBS utilizada pacientes con HDA no variceal atendidos en el servicio de urgencias posee una validez diagnóstica adecuada para predecir la necesidad de intervención.

Introduction: The Glasgow-Blatchford (GBS) scale allows us to classify the patient as a high or low risk of presenting complications. In the patients identified as "low risk", the performance of an early endoscopy could reduce the intrahospital days and the overall cost. In our environment, we do not know the usefulness of the GBS scale. Objective: To describe the utility of the Glasgow-Blatchford scale (GBS) in the stratification of risk in patients with non-variceal upper gastrointestinal bleeding (HDA) seen in the emergency department of a tertiary hospital. Materials and methods: 218 patients were prospectively included, and they were performed in the first 24-48 hr an urgent endoscopy. These were stratified, according to the GBS scale, at low risk (GBS ≤ 2), and high risk (GBS ≥ 3). We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the GBS scale in our setting based on the requirement of endoscopic, radiological treatment (arterial embolization), transfusion of blood products and / or surgery, as our gold standar to classify patients as "high risk". Results: A total of 218 patients were included, with a mean age of 56 ± 18 years, of which 121/218 (55%) were male. 156/218 required intervention for what were classified as "high risk" while 62/218 did not specify and classified as "low risk". A cut-off value of GBS ≤ 2 showed a sensitivity of 98% with a NPV of 100%. The utility of the GBS scale showed an area under the ROC curve 0.83 (95% CI 0.75-0.90). Conclusion: The GBS scale used in patients with non-variceal UGB attended in the emergency department has adequate diagnostic validity to predict the need for intervention.

Manifestaciones cutáneas de enfermedades gastrointestinales / Cutaneous manifestations of gastrointestinal diseases

The gastrointestinal system is closely related to the skin. Multiple disorders of the gastrointestinal tract that manifest clinically on the skin surface are recognized, which can even occur before establishing the definitive diagnosis of the disease. For this reason, it is necessary that the dermatologist is internalized regarding the wide variety of clinical signs that can guide the etiological study, which requires in most cases, a multidisciplinary management. (AU)

Mesocaval Shunt Creation for Jejunal Variceal Bleeding with Chronic Portal Vein Thrombosis

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.

Neurofibroma plexiforme del colédoco: una causa rara de ictericia obstructva. Reporte de caso / Plexiform Neurofibroma in the Common Bile Duct: A Rare Cause of Obstructve Jaundice. Case Report

Paciente masculino de 68 años, con ictericia obstructva quien es llevado a sala de operaciones encontrando una lesión que ocluye el 90% de la luz del tercio medio e inferior del colédoco que es reportada como un neurofbroma plexiforme del colédoco.

Male patent, 68 years old, with obstructve jaundice. Near total obstructon of common bile duct was found during laparotomy, pathology reported a plexiform neurofbroma in the common bile duct.

Aberrant right subclavian artery-esophageal fistula: massive upper gastrointestinal hemorrhage secondary to prolonged intubation / Fístula de artéria subclávia direita anômala com esôfago - hemorragia digestiva alta maciça secundária a intubação gástrica prolongada

ABSTRACT Aberrant right subclavian artery-esophageal fistula is a rare but potentially fatal complication. It may be associated with procedures, such as tracheostomy and tracheal or esophageal intubation, and yields massive upper gastrointestinal bleeding difficult to identify and to control. A high index of suspicion is essential for early diagnosis and better prognosis. We report a rare case of a patient who survived after emergent surgical procedure for massive upper gastrointestinal bleeding secondary to aberrant right subclavian artery-esophageal fistula after prolonged intubation.

RESUMO A fístula de artéria subclávia direita anômala com o esôfago é uma complicação rara, mas potencialmente fatal. Pode estar associada a procedimentos como traqueostomia e intubação traqueal ou esofágica e originar hemorragia digestiva alta maciça, de difícil identificação e controle. Um elevado índice de suspeição é essencial para o diagnóstico precoce e a melhoria do prognóstico. Relatamos caso raro de doente que sobreviveu após intervenção cirúrgica emergente por hemorragia digestiva alta maciça secundária a fístula de artéria subclávia direita anômala com esôfago, após intubação gástrica prolongada.

Infección masiva por Ancylostoma duodenale como causa de hemorragia intestinal y anemia severa / Massive hookworm infection as a cause of intestinal bleeding and severe anemia

El sangrado gastrointestinal masivo causado por uncinarias es raramente reportado. El caso de un paciente varón de 34 años que se presentó con hemorragia digestiva baja con evidencia de infección masiva por uncinarias en la colonoscopia es reportado en este manuscrito. Además, se discute la necesidad de considerar la infección por uncinarias como una posible etiología del sangrado gastrointestinal en áreas endémicas...

Overt gastrointestinal bleeding caused by hookworm infection is rarely reported. We present a 34 year old male with lower gastrointestinal bleeding with evidence of massive hookworm infection on colonoscopy and discuss the need to consider hookworm infection as a possible etiology of gastrointestinal bleed in endemic areas...

Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting

PURPOSE: To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. MATERIALS AND METHODS: From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. RESULTS: All technical and clinical success-i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control-was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12-32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. CONCLUSION: Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding.

Can Glasgow-Blatchford Score and Pre-endoscopic Rockall Score Predict the Occurrence of Hypotension in Initially Normotensive Patients with Non-variceal Upper Gastrointestinal Bleeding? / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department. METHODS: Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013. Study population was divided according to the development of hypotension, and demographics, comorbidities, and laboratory findings were compared. GBS and pre-E RS were estimated to predict the occurrence of hypotension. RESULTS: A total of 747 patients with non-variceal upper gastrointestinal bleeding were included during the study period, and 120 (16.1%) patients developed hypotesion within 24 hours after ED admission. The median values GBS and pre-E RS were statistically different according to the occurrence of hypotension (8.0 vs. 10.0, 2.0 vs. 3.0, respectively; p<0.001). In the receiver operating characteristic curve analysis of hypotension development, the area under the curve of GBS and pre-E RS were 66% and 64%, respectively. The sensitivity and the specificity of GBS using optimal cut-off value were 81% and 46%, respectively, while those based on the pre-E RS were 74% and 46%, respectively. CONCLUSIONS: GBS and pre-E RS were both not sufficient for predicting the occurrence of hypotension in non-variceal upper gastrointestinal bleeding. Development of other scoring systems are needed.

Hemorragias poco usuales en pacientes con hemofilia / Unusual bleeding in hemophilic patients

La hemofilia es una enfermedad hemorrágica grave con gran heterogeneidad fenotípica. Los sangramientos músculo-articulares constituyen la manifestación clínica más frecuente y significativa por las secuelas crónicas que originan. Sin embargo, existen otros sitios de sangramiento menos reiterados que pueden ser graves e invalidantes, y la posibilidad de reconocerlos tempranamente evita las consecuencias adversas. Se presentan dos pacientes de edad pediátrica que acudieron al servicio de urgencias por eventos hemorrágicos en sitios poco usuales: mediastinal, pulmonar y de rectos anteriores. A todos se les realizó un diagnóstico temprano del proceso patológico basado en un interrogatorio y examen físico detallados, apoyado con estudios imagenológicos (radiografía y ultrasonido) que permitieron manejar estas hemorragias de forma adecuada con terapia sustitutiva oportuna, sin complicaciones ulteriores. De esta forma se evidencia que el diagnóstico precoz es elemento fundamental en el seguimiento de los pacientes con hemofilia para evitar complicaciones de esta enfermedad(AU)

Hemophilia is a serious hemorrhagic disease with marked phenotypic heterogeneity. Muscle and joint bleedings are the most common clinical manifestation and they stand out by the resultant chronic sequelae. However, there are other less frequent types of bleeding disorders that can be severe and disabling and the possibility to recognize them early avoids adverse consequences. We present two pediatric patients who attended the emergency service with bleeding events in unusual places: mediastinal, pulmonary and rectus. These patients were early diagnosed based on a detailed interview and physical examination supported by imaging studies such as radiography and ultrasound which enabled the appropriate handling of these bleedings with opportune replacement therapy and without further complications. It is evident that early diagnosis is the key element in monitoring patients with hemophilia to prevent complications of the disease(AU)

Uso del ácido tranexámico como variante terapéutica en pacientes con sangrado digestivo alto no variceal / Use of tranexamic acid as a therapeutic variant in patients having high digestive blooding not from varix

Introducción: el sangrado digestivo alto no variceal es una de las primeras causas de ingreso hospitalario en el país, en los últimos años se convirtió en un grave y sensible problema de salud. Objetivo: caracterizar el comportamiento de las variables demográficas, clínicas y terapéuticas en los pacientes ingresados por esta enfermedad en el servicio de urgencia de Cirugía General del Hospital Universitario General Calixto García desde junio del 2012 a diciembre 2013. Métodos: se realizó un estudio observacional, analítico, prospectivo y de vigilancia poscomercialización para demostrar la efectividad del uso del ácido tranexámico como variante terapéutica precoz para detener el sangrado y evitar el resangrado en los pacientes con sangrado digestivo alto no variceal. Resultados: de un total de 104 pacientes, predominó el sexo masculino y los mayores de 70 años con 61,5 por ciento y 37,5 por ciento, respectivamente. Consumían café en exceso 94 por ciento, más del 50 por ciento, alcohol, 37 por ciento tomaba medicamentos antiinflamatorios no esteroideos. Del total de pacientes, 61,5 por ciento y el 55,8 por ciento padecían de hipertensión arterial y de gastritis crónica, respectivamente. La melena fue la forma de presentación clínica más frecuente de esta enfermedad; la endoscopia de urgencia se le realizó solo al 25 por ciento de los casos y predominó como diagnóstico la pangastritis eritematosa en el 51,1 por ciento de los pacientes. El tratamiento quirúrgico fue excepcional solo en el 2,9 por ciento de los pacientes del estudio, la estadía hospitalaria fue en el 84 por ciento de los enfermos menor de 3 días y la mortalidad general muy baja de un 1,9 por ciento. Conclusiones: los efectos del uso del ácido tranexámico en los pacientes con sangrado digestivo alto no variceal fueron beneficiosos para el tratamiento de esta enfermedad, las evidencias de sangrado activo luego de la aplicación del medicamento se redujeron de forma relevante, el tratamiento quirúrgico fue excepcional y la mortalidad muy baja(AU)

Introduction: Non-variceal upper gastrointestinal bleeding is one of the first causes of hospitalization in our country and it has become a serious and sensitive health problem in the last few years. Objective: To characterize the behaviour of the demographic, clinical and therapeutic variables found in patients admitted to the emergency general surgery service of General Calixto Garcia university hospital due to this disease from June 2012 to December 2013. Methods: Observational, analytical, prospective and postmarket surveillance study to prove the effectiveness of the tranexamic acid as an early therapeutic variant to stop bleeding and avoid re-bleeding in those patients with non-variceal upper gastrointestinal bleeding. Results: In the study group of 104 patients, males and over 70 years-old people predominated for 61.5 percent and 37.5 percent, respectively. The coffee overconsumption was seen in 94 percent, more than 50 percent took alcohol and 37 percent had non-steroidal antinflammatory drugs treatment. Of the total number of patients, 61.5 percent and 55.8 percent suffered blood hypertension and chronic gastritis, respectively. Melena was the most frequent presentation of this disease; urgent endoscopoy was performed in just 25 percent of casos and the predominant diagnosis was erythematous pangastritis in 51.1 percent of patients. The surgical treatment was used in just 2.5 percent of the study patients, the lenght of stay at hospital was less than 3 days in 84 percent and very low overall mortality rate of 1.9 percent. Conclusions: The effects of the tranexamic acido n patients with non-variceal upper gastrointestinal bleeding were benefitial for treating the disease; evidence of active bleeding after the use of drug significantly decrease, surgical treatment was an exception and mortality rate was very low(AU)

Jejunal Varices Causing Recurrent Obscure Gastrointestinal Hemorrhage / 대한소화기학회지

No abstract available.

Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae / Tratamento endovascular de pseudoaneurisma traumatico e fistulas arteriovenosas em vasos iliacos externos

A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.

Um paciente do sexo masculino com 17 anos de idade apresentando-se com ferimento abdominal por arma de fogo e choque hipovolêmico grave foi inicialmente operado e apresentava várias lesões no intestino delgado e ceco associadas a hemorragia grave. O paciente teve que ser operado duas vezes devido a hipotermia, acidose e coagulopatia. No período pós-operatório tardio, foram observados sopro e frêmito. Angiografia revelou um pseudoaneurisma associado a fístulas arteriovenosas nos vasos ilíacos externos ao lado esquerdo. As lesões foram tratadas mediante a colocação de stent na artéria ilíaca externa, com desfecho satisfatório. Tomografia computadorizada de controle realizada após 6 meses evidenciou integridade da artéria, com o fechamento das fístulas. O tratamento endovascular deve ser o método de escolha nesse tipo de complicação vascular traumática.

Utilidad diagnóstica de la cápsula endoscópica en el Hospital Guillermo Almenara Irigoyen EsSalud año 2010-2012 / Diagnostic utility of capsule endoscopy at the Hospital Guillermo Almenara Irigoyen EsSalud year 2010-2012

La CE (capsula endoscópica) fue aprobada en el 2001 por la FDA para el estudio de las diversas patologías del intestino delgado y está indicada en casos de hemorragia digestiva de origen oscura (HDOO), enfermedad inflamatoria intestinal, enfermedad celiaca, diarrea crónica, síndromes de poliposis familiar, tumores del intestino delgado. OBJETIVOS: Evaluar la utilidad diagnostica de la CE, describir los factores de riesgo importantes, las indicaciones clínicas más frecuentes, los hallazgos más destacables y las complicaciones que hubiera. MATERIALES y METODOS: Se trata de un estudio transversal, descriptivo, retrospectivo donde se analizaron las historias clínicas e informes de 116 pacientes a quienes se les realizo la CE en el Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen entre marzo del 2010 y junio del 2012, el procesamiento de la información se hizo a través del software estadístico SPSS-Versión 17.0. RESULTADOS: EI grupo etáreo más frecuente correspondió a los adulto mayores con 55 pacientes (47.4 por ciento), 70 pacientes fueron del sexo femenino y 46 masculinos, la mayoría no tuvo antecedentes personales o familiares de importancia (56 por ciento), la indicación clínica más frecuente fue la hemorragia de origen oscuro oculto (HDOO) 34 pacientes (29 por ciento) diarrea 33 pacientes (28.4 por ciento), hemorragia de origen oscuro evidente (HDOE) 32 pacientes (27,6 por ciento), dolor abdominal 10 pacientes (8,6 por ciento), sospecha de cáncer 4 pacientes (3,4 por ciento) y sospecha de poliposis 3 pacientes (2,6 por ciento) el rendimiento diagnóstico fue del 60 por ciento. Los hallazgos fueron: ulceras (22 pacientes, 19 por ciento), angiectasias (14 pacientes, 12 por ciento), tumores (13 pacientes, 11 por ciento), poliposis (2 pacientes, 2 por ciento) enfermedad celiaca (3 pacientes, 3 por ciento) y parásitos (3 pacientes, 3 por ciento). Las ulceras fueron más frecuente en el grupo de adultos maduros (26 a 60 años) 10.3...

The capsule endoscopy was approved by FDA to the study of many small bowel diseases and is indicated in obscure gastrointestinal bleeding (OGIB) inflammatory intestinal disease, celiac disease, chronic diarrhea, hereditary polyposis syndrome, tumors of small bowel. OBJECTIVES: Study the diagnostic utility of CE, describe the most important factors of risk, the more frequently clinical indications, the findings more remarkable and the probable complications. METHODOLOGY: It was a transversal descriptive retrospective study that analyzed the clinic histories and the test of 116 patients they were made capsule endoscopy in the unity of gastroenterology that Guillermo Almenara hospital between March 2010 and June 2012, the prosecution of the information was made in the SPSS statistic software 17.0 version. RESULTS: The age of group more frequently was the elderly persons with 55 patients (47.4 per cent), 70 patients were female and 46 patients were male, the majority had not homely and personal background (56 per cent), the clinic indication more frequently was the obscure gastrointestinal bleeding occult (OGIBO) 34 patients, (29 per cent), diarrhea 33 patients (28.4 per cent), obscure gastrointestinal bleeding overt (OGIBE) 32 patients (27,6 per cent), abdominal pain 10 patients (8.6 per cent), suspect of cancer 4 patients (3.4 per cent) and suspect of polyposis 3 patients (2.6 per cent), the performance diagnosis was of 60 per cent. The findings were: ulcers (22 patients, 19 per cent), Angiodysplasia (14 patients, 12 per cent), tumors (13 patients, 11 per cent), polyps (2 patients, 2 per cent), celiac disease (3 patients, 3 per cent) and vermin (3 patients, 3 per cent). The ulcers were more frequently in the adults mature (26 to 60 years old) 10.3 per cent (12 patients).The unique complication was the retention of the capsule in 5 patients (4.3 per cent). CONCLUSIONS: The capsule endoscopy is a good tool for the study of pathologies of the small bowel with an...

A Case of Dieulafoy Lesion of the Jejunum Presented with Massive Hemorrhage / 대한소화기학회지

The Dieulafoy lesion is a rare cause of severe gastrointestinal hemorrhage. Although it may occur anywhere in the gastrointestinal tract, the lesion is most commonly located in the stomach, and the small bowel is an extremely uncommon site. Since Dieulafoy lesion in the small bowel is difficult to access by endoscopy, it seems impossible to diagnose and treat by initial endoscopy unlike the lesions in stomach. We experienced a case of Dieulafoy lesion of jejunum with massive hemorrhage in 54-year-old male. Active jejunal bleeding was shown by computed tomography scan and mesenteric angiography. Partial resection of the jejunum was performed. Final pathologic finding revealed Dieulafoy lesion of the jejunum.

A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding / 대한소화기학회지

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.