Olmesartan-associated Enteropathy / 中国医学科学院学报

Olmesartan,an angiotensin Ⅱ receptor blocker,is a commonly used antihypertensive drug.Several case reports and cohort studies in recent years have described a severe gastrointestinal adverse event with chronic diarrhea,intestinal malabsorption,and weight loss after the administration of olmesartan.In such cases,the patients recovered after discontinuing olmesartan.This adverse effect is called olmesartan-associated enteropathy(OAE).This article reviews the potential pathogenesis and clinical characteristics of OAE,which broadens the disease spectrum for the differential diagnosis of chronic diarrhea and intestinal malabsorption.

Use of oral fluids to detect anti Lawsonia intracellularis antibodies in experimentally infected pigs / Utilização de fluidos orais para detecção de anticorpos anti Lawsonia intracellularis em suínos experimentalmente infectados

Several pathogens and antibodies derived from serum or produced in tissues associated with the oral cavity are present in the oral fluid (OF). Considering the applicability of this alternative sample, recent studies in veterinary medicine have tested OF as a replacement for serum in diagnostic assays. The aim of this study was to standardize the immunoperoxidase monolayer assay (IPMA) to detect anti-Lawsonia intracellularis immunoglobulin A (IgA) and immunoglobulin G (IgG) in OF samples from experimentally infected pigs. Sixty-two pigs were divided into two groups: control (T1, n=30) and inoculated with L. intracellularis (T2, n=32). Blood, OF and fecal samples were collected at 0, 7, 14, 21, 28 and 42 days post-inoculation (dpi). Some adaptations of the standard technique for serum were made to IPMA for the detection of IgA and IgG in OF. The IPMA showed high specificity and sensitivity for serum samples and high specificity and moderate sensitivity for the detection of IgA and IgG in OF. There was high agreement between the results of serum IgG and OF IgA and IgG. Based on our results, oral fluid samples may be used for the evaluation and determination of anti-L. intracellularis antibodies in pigs, but not for individual diagnosis of swine proliferative enteropathy.(AU)

Vários patógenos e anticorpos derivados do soro ou produzidos em tecidos associados a cavidade oral estão presentes no fluido oral (FO). Considerando a aplicabilidade dessa amostra alternativa, estudos recentes em medicina veterinária têm testado o FO como substituto do soro para testes diagnósticos. O objetivo desse estudo foi padronizar a imunoperoxidase em monocamada de célula (IPMC) para a detecção de imunoglobulina A e imunoglobulina G anti-Lawsonia intracellularis em amostras de FO de suínos experimentalmente infectados. Um total de 62 suínos foram divididos em dois grupos: controle (T1, n=30) e inoculados com L. intracellularis (T2, n=32). Sangue, FO e amostras de fezes foram coletados aos 0, 7,14, 21, 28 e 42 dias após a inoculação (dpi). Algumas adaptações da técnica foram realizadas na técnica padrão da IPMC para a detecção de IgA e IgG. A IPMC demostrou alta especificidade e sensibilidade para amostras de soro e alta especificidade de moderada sensibilidade para a detecção de IgA e IgG em FO. Houve alta concordância entre resultados de detecção de IgG em soro com a IgA e IgG em amostras de FO. Baseado em nossos resultados, amostras de fluido oral podem ser usadas em avaliações e detecção de anticorpos anti-L. intracellularis em suínos, porém não de forma individual.(AU)

Manejo quirúrgico de la endometriosis colorrectal: monografía destacada del curso de la SACP 2019 / Surgical Management of Colorectal Endometriosis: featured monograph from the 2019 SACP Course

La endometriosis es una de las patologías ginecológicas benignas más frecuente, ocurre en un 7-10% de las mujeres en edad reproductiva y es causal de dolores crónicos e infertilidad. Se trata de una población joven y sana por lo demás. La sospecha diagnóstica de esta entidad debe ser alta y su manejo multidisciplinario.La endometriosis colorrectal representa una variable altamente incapacitante y es aquí donde se plantea la necesidad de un tratamiento más agresivo para su resolución. Frente a esto nos preguntamos, ¿qué rol tiene la cirugía?, ¿cuáles serían sus ventajas y desventajas?, ¿por qué deberíamos elegirla como método terapéutico?.La presente monografía fue inspirada en todas las pacientes que nos plantearon esta controversia. Que motivaron interconsultas, ateneos, búsqueda de bibliografía. Que generaron discusiones, dudas e incertidumbres y nos hicieron salir del rol de cirujanos al que estamos habituados y nos enseñaron a acompañar, cuando no pudimos curar

Falla intestinal. Artículo de revisión / Intestinal failure Review article

La falla intestinal (FI) se define como la disminución de la función del intestino por debajo de lo mínimo necesario para la absorción de los macronutrientes y / o agua y electrolitos, de tal manera que se requiere de la suplementación intravenosa (SIV) para mantener la salud y el crecimiento. Desde el punto de vista funcional se clasifica en tres tipos. FI tipo I: condición aguda, de corto duración y generalmente auto limitada, FI tipo II: estado agudo prolongado, a menudo en pacientes metabólicamente inestables, que requieren cuidado multidisciplinario y SIV durante períodos de una semana o meses, acompañada de complicaciones sépticas, metabólicas y nutricionales y FI tipo III: condición crónica, en pacientes metabólicamente estables, que requieren SIV durante meses o años. Su manejo requiere de terapia nutricional y en casos seleccionados cirugía autóloga de reconstrucción(AU)

Intestinal failure (FI) is defined as the decrease in intestinal function below the minimum necessary for the absorption of macronutrients and / or water and electrolytes, in such a way that intravenous supplementation (IVS) is required to maintain health and growth. From a functional point of view, it is classified into three types. FI type I: acute condition, of short duration and generally self-limited, FI type II: prolonged acute state, often in metabolically unstable patients, requiring multidisciplinary care and SIV for periods of a week or months, accompanied by septic, metabolic and nutrition and FI type III: chronic condition, in metabolically stable patients, who require SIV for months or years. Its management requires nutritional therapy and in selected cases autologous reconstruction surgery(AU)

Enteroscopia asistida por balón simple en el manejo de la patología del intestino delgado: Experiencia de la Unidad de Intestino Delgado de la Clínica Anglo Americana durante el periodo de diciembre del 2012 a diciembre del 2018 / Single balloon enteroscopy in the management of small bowel pathology: Experience of the Small Bowel Unit - British American Hospital from December 2012 to December 2018

Objetivo: Describir la experiencia en el uso de la enteroscopia asistida por balón simple para el diagnóstico y manejo de la patología del intestino delgado en pacientes con anatomía normal y alterada por cirugía en la Clínica Anglo Americana. Material y método: El presente es un estudio descriptivo - retrospectivo que incluye a todos los pacientes que acudieron a la Unidad de Intestino Delgado de la Clínica Anglo Americana, para realizarse una enteroscopia asistida por balón durante el periodo comprendido entre diciembre del 2012 a diciembre del 2018. Resultados: Se realizaron 80 procedimientos de enteroscopia asistida por balón simple, 49 fueron realizados por via anterógrada y 31 por vía retrógrada. La edad promedio fue 60,78 años (20 a 88 años). 48 pacientes (60%) eran varones. El tiempo de inserción media fue 80 minutos para la vía anterógrada (55 - 141 minutos) y 110 minutos para la vía retrógrada (55 -180 minutos). La principal indicación para realizar la enteroscopia por balón simple fue hemorragia digestiva oscura, 45 casos (56,25%). Se realizaron 6 estudios de enteroscopias asistida por balón en pacientes con anatomía alterada (7,5%). Setenta de los ochenta procedimientos (87,5%) fueron realizados con sedación administrada por enfermería supervisada por gastroenterólogo en base a midazolam, petidina y propofol, no se presentó ninguna complicación respiratoria o hemodinámica. Los diagnósticos obtenidos más frecuentes por enteroscopia fueron: angiodisplasias de intestino delgado (20%), úlceras yeyuno ileales (17,5%) y neoplasias a nivel del intestino delgado (7,5%). La complicación que se presentó con más frecuencia posterior a la enteroscopia fue el íleo paralítico, 2 casos, y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento. Conclusiones: La hemorragia digestiva oscura fue la principal indicación para realizar una enteroscopia asistida por balón simple. Los diagnósticos más frecuentes fueron angiodisplasias, úlceras yeyuno ileales y neoplasias a nivel del intestino delgado. La complicación más frecuente fue el íleo paralítico y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento.

Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. Material and methods: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. Results: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. Conclusion: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure

Nutrición parenteral domiciliaria en pacientes pediátricos con insuficiencia intestinal / Home parenteral nutrition in pediatric patients with intestinal insufficiency

INTRODUCCIÓN: La Nutrición Parenteral Domiciliaria (NPD) ha demostrado ofrecer importantes be neficios para los pacientes y el sistema de salud. En Chile se desconoce el número de pacientes que se encuentran recibiendo esta modalidad de tratamiento o que podrían ser candidatos a ella. OBJETIVO: Determinar la prevalencia y características clínicas de pacientes con Insuficiencia Intestinal (II) que reciben actualmente NPD o que son candidatos a esta. PACIENTES Y MÉTODO: Estudio descriptivo transversal que incluyó pacientes de 0 a 18 años, con diagnóstico de II que se encontraban recibiendo NP por un tiempo superior a 3 meses en el domicilio, o en el hospital con situación clínica estable y con catéter venoso de larga duración (CVC). A través de una encuesta digitalizada se recolectaron y estudiaron las variables: sexo, antecedentes de nacimiento, indicación para iniciar soporte nutricional parenteral, edad de inicio de NP, tipo de CVC utilizado, frecuencia de NP, estado nutricional, alimentación al último control y complicaciones asociadas al uso de NP. Se utilizó el Programa SPSS Statistics, Versión 21, Macintosh, para el análisis de los datos. El análisis descriptivo consideró análisis de frecuencia y medidas de tendencia central. La prueba de Chi cuadrado y de Fisher se usaron para la comparación de proporciones. RESULTADOS: Se registraron datos de 46 pacientes, cuya edad promedio fue de 55,5 meses. La principal indicación para iniciar la Nutrición Parenteral (NP) fue la disminución de la superficie intestinal (78,3%.). El 63% de los pacientes se encontraba hospitalizado. No se encontraron diferencias significativas entre el lugar de tratamiento y las variables estado nutricional e infecciones de catéter en el último año. CONCLUSIONES: Se identificó la prevalencia de pacientes con NP prolongada y sus características clínicas. No se encontraron diferencias que respalden la entrega de este tratamiento en el hospital por sobre el domicilio. Es necesario desarrollar políticas públicas que garanticen la opción de recibir este tratamiento en el domicilio.

INTRODUCTION: Home parenteral nutrition (HPN) has been shown to offer important benefits for pa tients and the health system. In Chile, the number of patients who are receiving this type of treatment or who could be candidates for it is unknown. OBJECTIVE: To determine the prevalence and clinical characteristics of patients with intestinal insufficiency (II) currently receiving HPN or who are can didates for it. PATIENTS Y METHOD: Cross-sectional descriptive study which included patients aged between 0 to 18 years with diagnosis of II who were receiving parenteral nutrition (PN) for over three months, either at home or in the hospital, with a stable clinical situation and a long-term venous catheter (CVC). Through a digitalized survey, the following variables were collected and studied: gender, birth history, indication to initiate parenteral nutritional support, age of initiation of PN, type of CVC, frequency of PN, nutritional status and feeding in the last control and complications as sociated with the use of PN. Data analysis was performed using the SPSS Statistics Software, Version 21, Macintosh. The descriptive analysis considered frequency analysis and central trend measures. The Chi-square and Fisher tests were used for comparison of proportions. RESULTS: Data from 46 patients were recorded. The average age was 55.5 months. The main indication for initiating the PN was the decrease of the intestinal surface (78.3%). 63% of the patients were hospitalized. No significant differences were found between the place of treatment and the nutritional status and catheter infections variables in the last year. CONCLUSIONS: The prevalence of patients with long-term PN and their clinical characteristics were identified. No differences were found to support the administration of this treatment in the hospital over the home. Public policies must be developed to guarantee the option of receiving this treatment at home.

Fallo intestinal agudo en el paciente crítico / Insuficiência intestinal aguda em pacientes críticos / Acute intestinal failure in critically patients

Introducción: el fallo intestinal agudo determina en gran medida la mortalidad del paciente crítico. Objetivo: brindar a los profesionales de la salud las bases teóricas esenciales que sustenten su autopreparación para la prevención, diagnóstico y tratamiento del fallo intestinal agudo. Método: se realizó una revisión bibliográfica en la Facultad de Ciencias Médicas de Guantánamo, entre enero y julio de 2018, con una sistematización teórica sobre el tema. Se estudiaron 45 artículos de los 145 que se encontraron publicados entre los años 2010 y 2018 en las bases de datos electrónicas. Resultados: se elaboró una monografía sobre el fallo intestinal agudo que contuvo los siguientes núcleos de conocimientos: definición, fisiopatología, etiología, diagnóstico y tratamiento. Conclusiones: es ineludible la habilitación de los profesionales para la prevención y diagnóstico precoz del fallo intestinal agudo porque este determina en gran medida la sepsis, el fallo multiorgánico y la mortalidad del paciente crítico(AU)

Introduction: acute intestinal failure can cause mortality n critically patients. Objective: provide the health professionals essential theoretical foundations that support their selfpreparation for the prevention, diagnosis and treatment of acute intestinal failure. Method: a literature review was done at the Faculty of Medical Sciences of Guantanamo, between January and July 2018, with a theoretical systematization on the subject. 45 articles found 145 that were published between 2010 and 2018 in electronic databases that were studied. Results: a case - study on the acute intestinal failure was developed which contained the following kernel of knowledges: definition, pathophysiology, etiology, diagnosis and treatment: Conclusions: it is unavoidable enabling professionals to prevention and early diagnosis of acute intestinal failure because it is determined sepsis, multiple organ failure and mortality on critically ill patients(AU)

Introdução: a insuficiência intestinal aguda determina em grande parte a mortalidade do paciente crítico. Objetivo: fornecer aosprofissionais de saúde as bases teóricas essenciais que sustentam sua autopreparação para a prevenção, diagnóstico e tratamento da insuficiência intestinal aguda. Método: revisão bibliográfica realizada na Faculdade de Ciências Médicas de Guantánamo, no período de janeiro a julho de 2018, com uma sistematização teórica sobre o tema. Estudamos 45 artigos dos 145 publicados entre 2010 e 2018 nas bases de dados eletrônicas. Resultados: foi elaborada uma monografia sobre insuficiência intestinal aguda que continha os seguintes núcleos de conhecimento: definição, fisiopatologia, etiologia, diagnóstico e tratamento. Conclusões: a qualificação de profissionais para a prevenção e diagnóstico precoce da insuficiência intestinal aguda é inescapável, pois determina em grande parte sepse, falência de múltiplos órgãos e mortalidade do paciente crítico(AU)

Oclusión intestinal por duplicación intestinal: diagnóstico y tratamiento en urgencias / Intestinal occlusion by intestinal duplication: diagnosis and treatment in the emergency

Las duplicaciones intestinales son anomalías congénitas; se han descrito a lo largo de todo el tracto digestivo con una presentación clínica inespecífica. Reportamos el caso clínico de un paciente de 83 años intervenido quirúrgicamente por una oclusión intestinal por duplicación intestinal del íleon terminal. Discutimos la presentación clínica, estudios de imagen, procedimiento quirúrgico y resultados del tratamiento. Revisamos la literatura actual pertinente por ser un hallazgo etiológico de oclusión intestinal poco frecuente.

The intestinal duplication are congenital abnormalities; have been described throughout the digestive tract with a nonspecific clinical presentation. We report the clinical case of a patient of 83 years underwent surgery for an intestinal occlusion by intestinal duplication of the terminal ileum. We discuss the clinical presentation, image studies, surgical procedure and results of treatment. We review the current literature relevant to be a finding etiological diagnosis of intestinal occlusion rare.

Evisceración vaginal tras tratamiento con radioterapia e histerectomía abdominal / Vaginal evisceration after treatment with radiotherapy and abdominal hysterectomy

La evisceración vaginal es una complicación muy rara. Es más frecuente en mujeres posmenopáusicas y con antecedente de cirugía vaginal, fundamentalmente histerectomía. También puede darse en mujeres premenopáusicas, vinculándose en estos casos a traumatismos, iatrogenia o introducción de cuerpos extraños. El íleon distal es el órgano más frecuentemente eviscerado, aunque el prolapso de epiplón, trompas de Falopio y apéndice también se han descrito. Presentamos el caso de una mujer de 43 años con evisceración transvaginal de epiplón a los seis meses de realizarse una histerectomía abdominal por recidiva de un cáncer escamoso de cérvix.

Vaginal evisceration is a very rare complication. It is more often in postmenopausal women with a history of vaginal surgery, mainly hysterectomy. It can also occur in premenopausal women, linking these cases to trauma, iatrogenic or foreign bodies. The distal ileum is most often gutted organ prolapse, although omentum, fallopian tubes and appendix are also described. We report a 43-year old transvaginal omental evisceration after six months of an abdominal hysterectomy for recurrent squamous cervical cancer.

A Rare Case of Bowel Gangrene in Pregnancy : A Surgical and Obstetric Catastrophe.

An unusual case of bowel gangrene involving jejunum upto the middescending colon leading to septicaemic shock, presented as a case of placental abruption with IUD with shock. Case Report : The 25 year old primigravida patient with 34 weeks of gestation was referred from peripheral obstetrician to SVNGMC, in a state of shock with clinical features suggestive of concealed type of placental abruption with IUD. In view of placental abruption with shock, emergency caesarean section was performed. Per Operative Findings: Foul smelling peritoneal fluid, IUD. Baby with placental separation with RP clot and gangrenous bowel from jejunum to middescending colon. As such long segment of bowel was involved; surgeon decided resection and end to end anastomosis was not possible. Propable diagnosis like superior mesenteric artery thrombosis/ Embolism was made. pt was put on low dose inj. Heparin and later managed in Surgical I.C.U. & succumbed on day 3 postop. Conclusion: Hypercoagulable state normally found in pregnant women which is believed to result in superior mesenteric vessel thrombosis and then intestinal ischaemia. It is extremely important not to miss any complaint like pain in abdomen and other G.I. complaints that may have any surgical or medical pathology associated with pregnancy.

Haga su diagnóstico / Make your diagnosis

El diagnóstico es: síndrome megavejiga-microcolon-hipoperistaltismo intestinal: SMMHI

Outcome Predictors for Intestinal Behcet's Disease

Behcet's disease (BD) is a multisystem inflammatory disorder that presents as recurrent oral and genital ulcers in conjunction with other dermatological and ocular manifestations. The prevalence of BD is higher in Middle and East Asia than in Western countries. Intestinal BD is a specific subtype of BD, characterized by intestinal ulcers and associated gastrointestinal symptoms. Similar to inflammatory bowel disease, intestinal BD exhibits a fluctuating disease course with repeated episodes of relapse and remission that necessitate adequate maintenance therapy after achievement of clinical remission. Medical treatment of intestinal BD is largely empirical since well-controlled studies have been difficult to perform due to the heterogeneity and rarity of the disease. To date, 5-aminosalicylic acid, systemic corticosteroids, and immunosuppressants have been used anecdotally to treat intestinal BD. The clinical course of intestinal BD shows considerable variability, and the exact point at which more potent agents such as immunosuppressants should be used has not yet been elucidated. Given the difficulty in predicting which patients will experience complicated disease courses and the fact that these drugs are related with certain risk resulting from immunosuppression, proper identification of prognostic factors in intestinal BD may allow physicians to implement tailored medical therapy and individualized patient monitoring based on risk stratification. In this review, the impact of baseline characteristics on the long-term course of intestinal BD, prognostic factors during various medical therapies, and outcome predictors related to surgery will be discussed.

Sobrecrecimiento bacteriano como etiología de dolor cronico no oncológico visceral / Small bowel bacterial overgrowth a cause of visceral noncancer chronic pain

El dolor visceral crónico se produce por la distención de los receptores neuronales localizados en las mucosas de los distintos órganos del aparato digestivo, presentándose clínicamente como un dolor con una localización difusa, con intensidad moderada a severa, que se describe generalmente de tipo cólico. Presentamos un caso clínico de una paciente con que consultó por un dolor crónico no oncológico de tipo visceral con componente neuropático, cuya causa etiológica correspondió a sobrecrecimieno bacteriano intestinal. Por lo que debemos considerar esta patología como etiología de un dolor visceral crónico...

Chronic Visceral pain is caused by the distension of neuronal receptors located in the lining the digestive organs, clinically presenting as pain with a diffuse localization and moderate to severe intensity, usually is described colicky. We present a case report a patient who presented with chronic noncancer visceral pain with neuropathic component, which accounted etiology Small intestinal bacterial overgrowth. We must consider this disease as a cause of chronic visceral pain...

Human intestinal capillariasis: A rare case report from non-endemic area (Andhra Pradesh, India).

Human intestinal capillariasis is caused by Capillaria philippinensis. This disease is endemic in Philippines and Thailand. To the best of our knowledge, we report the third case of human intestinal capillariasis from India and the first case from Andhra Pradesh, which is a non-endemic area. A 40-year-old female presented with diarrhoea, vomiting, decreased urinary output, ascitis, pedal oedema, hypoalbuminemia, and electrolyte imbalance. Microscopic examination of stool sample revealed the presence of ova, larvae, and adult worms of C. philippinensis. Patient recovered from the disease after taking albendazole 400 mg daily for 1 month along with supportive treatment.

Lipomatosis intestinal múltiple: informe de un caso / Multiple intestinal lipomatosis: case report

Introducción: La lipomatosis intestinal es una rara enfermedad con una incidencia en autopsias de 0.04 a 4.5 %. Pocos casos se han informado en la literatura médica. La condición es por lo general asintomática. Los casos sintomáticos se presentan con obstrucción o, con menor frecuencia, hemorragia. Los estudios con bario, ultrasonografía y tomografía computarizada son los procedimientos diagnósticos más comunes. Caso clínico: Hombre de 51 años de edad evaluado por dolor abdominal progresivo, taquicardia, cefalea y náusea. Fue estudiado un año antes por hemorragia gastrointestinal sin diagnóstico definitivo. La tomografía computarizada de abdomen con contraste demostró múltiples masas submucosas en estómago e intestino delgado. Las características del estudio con bario y tomografía computarizada fueron típicas de lipomatosis, por lo que no se realizaron procedimientos invasivos o quirúrgicos. El paciente se ha mantenido asintomático por un año. Conclusiones: Los tumores benignos del intestino delgado son relativamente raros, siendo el lipoma el tipo más común. El caso informado es inusual debido a la afección de estómago, duodeno, yeyuno e íleon. Los lipomas por lo general se presentan con superficie lisa y defectos de llenado no ulcerados. Con los hallazgos radiológicos típicos es posible hacer el diagnóstico preoperatorio si se considera esta rara enfermedad.

BACKGROUND: Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04 to 4.5%. Few cases have been reported in the medical literature. The condition is usually asymptomatic. Symptomatic cases usually present as obstruction or, less frequently, as bleeding. Intestinal barium studies, ultrasonography and computed tomography (CT) are useful diagnostic techniques. CLINICAL CASE: A 51-year-old male was evaluated for progressive abdominal pain, tachycardia, headache and nausea. One year before this examination, he was evaluated for gastrointestinal bleeding. Abdominal CT with contrast enhancement demonstrated multiple submucosal masses in stomach and small bowel. CT and barium examination features were typical of lipomas. No specific treatment, invasive procedures or surgery were performed for the asymptomatic intestinal lipomas. The patient has remained symptom-free for 1 year. CONCLUSIONS: Benign tumors of the small bowel are relatively rare, with lipoma being the most common type. The case reported here is considered to be unusual because stomach, duodenum, jejunum and ileum were affected. Lipomas are usually seen as smooth, nonulcerated filling defects. With these typical radiographic findings, preoperative diagnosis is possible keeping in mind this rare disease.

Utilidad de la cápsula endoscópica como método diagnóstico en el estudio de patología de intestino delgado / Experience with capsule endoscopy diagnostic tool for the small intestine

Background: Wireless capsule endoscopy (CE) is a relatively new method to evaluate the small intestine. Aim: To evaluate the indications of CE in our center and assess whether specific indications are associated with best results during CE studies. Material and Methods: Retrospective analysis of 69 patients aged 9 to 85 years (36 males) subjected to a CE at our institution between April 2004 and October 2007. Results: The most common indications for CE were overt gastrointestinal bleeding in 43.5 percent of patients, iron deficiency anemia in 39.1 percent, suspicion of a small bowel tumor in 4.3 percent, chronic diarrhea in 4.3 percent and abdominalpain in 2.9 percent. CE was normal in 23.2 percent and was able to find lesions in 76.8 percent of the studies. Gastrointestinal bleeding, followed by iron deficiency anemia were the indications associated with the higher rates of positive findings during CE. Conclusions: Gastrointestinal bleeding and iron deficiency anemia were the indications that obtained the best diagnostic y ield for CE.

First report of intestinal myiasis due to eristalis tenax in Iran

Eristalis tenax, belonging to order Diptera, family Syrphidae seldomly causes intestinal myiasis. Intestinal myiasis caused by E. tenax larvae is a rare manifestation found in both humans and other vertebrate animals. We report a 22-year-old woman presented with this myiasis. The larva in her stool sample was identified as E. tenax related to its typical morphology and authentic clues. Lack of specific control measures in the domestic water supply system was the most probable cause of this infestation