Pneumatosis quística intestinalis: presentación de un caso y revisión de la literatura / [Pneumatosis cystoides intestinalis: a case report and review of the literature].

Pneumatosis cystoides intestinalis features the presence of subserum or submucous cysts with gas in the intestinal wall. Its prevalence is 0.03

, although it has increased in the past decades due to a greater use of colonoscopy in everyday medical practice. Though there are several theories about its origin and many associated diseases were reported, its pathogenesis still remains uncertain. It is generally diagnosed as a finding in an imaging test. The treatment depends on the severity of the associated disease and symptoms. We report the case of a 59-year-old woman, heavy smoker, with no other clinical conditions who took a medical consultation due to abdominal bloating. She underwent a screening colonoscopy which detected the existence of cysts on the colonic wall. Afterwards, a computed tomography was performed and showed apical lung bullae, gas in a colonic wall segment, and ascitis associated to a big anexial tumor. She underwent a cytoreductive surgery, confirming the presence of advanced ovary neoplasm. The endoscopic biopsy confirmed the diagnosis of penumatosis cystoides intestinalis. We report these case because it is a rare entity which requires uncommon management and treatment guidelines.

Diagnóstico y manejo endoscópico de las complicaciones biliares postoperatorias / Diagnosis and endoscopic management of postoperative biliary complications

El manejo exitoso de las complicaciones biliares requiere la intervención de un equipo multidisciplinario, que incorpore a endoscopistas, radiólogos intervencionistas y cirujanos. El abordaje del paciente depende de la naturaleza y extensión de la complicación, la presencia o no de colecciones biliares y el momento del diagnóstico de la lesión. El trauma durante la colecistectomía da cuenta de más de 65% de las estenosis biliares postoperatorias de pacientes derivados para terapéutica endoscópica, y la combinación de colecistectomía y exploración del conducto biliar común adiciona 24%. El daño biliar que ocurre durante otros procedimientos (anastomosis biliodigestiva, gastrectomía, resección hepática parcial y colecistostomía) contribuye con relativamente pocos casos. Los resultados de la terapéutica endoscópica para las lesiones del tracto biliar mayor en pacientes seleccionados, son por lo menos comparables con los de la cirugía. En muchos de estos pacientes, el tratamiento endoscópico puede ser la única intervención terapéutica necesaria.

The successful management of post operative biliary complications requires a multidisciplinary team including endoscopists, interventional radiologists and surgeons. The patient approach depends on the type and length of the lesion, the presence of bile collections and the time of the diagnosis. The post cholecystectomy lesions involve more than 65% of biliary stenosis sent to endoscopic therapy, and the combination of cholecystectomy and common bile duct exploration adds another 24%. The biliary injuries related to other procedures (biliodigestive anastomosis, gastrectomy, partial hepatic resection and cholecystostomy) add a few more cases. The outcome of endoscopic therapy for main biliary tract lesions in selected patients is at least comparable with surgery. For many patients, the endoscopic therapy might be the only procedure required.