[Gastric tricobezoar: a rare cause of tumoral syndrome and pyloric obstruction]. / Tricobezoar gástrico: una causa poco frecuente de síndrome tumoral y de obstrucción pilórica.

UNLABELLED: A Trichobezoar is a rare tumoral mass of the gastrointestinal tract, formed mainly from the ingestion of hair. It contains also mucus and foods debris. CASE PRESENTATION: A 22 years old female with a 10 years history of surgery secondary to gastric foreign body (trichobezoar), presents with abdominal pain, swelling, nausea and vomiting. Physical examination of the abdomen revealed a palpable mass in the epigastric and left upper quadrant regions. It was also noted areas of alopecia of the scalp. DISCUSSION: Ninety percent of the trichobezoars present in females with a high frequency between 10-19 years. The treatment of bezoars (unless small in size) is mainly surgical. A psychiatric evaluation and follow up is important after surgery hence in most cases there is a psychological disorder that lead to the ingestion of hair.

Tricobezoar gástrico: una causa poco frecuente de síndrome tumoral y de obstrucción pilórica / Gastric Tricobezoar: a rare cause of tumoral syndrome and pyloric obstruction

El tricobezoar es una rara formación tumoral gástrica causada por un cuerpo extraño compuesto fundamentalmente por pelo; también contiene moco y fragmentos de alimentos. Presentación del caso: Paciente de 22 años que hace 10 años fue intervenida por cuerpo extraño gástrico (tricobezoar), ahora refiere cuadro de dolor abdominal, distensión, náuseas y vómitos, al examen físico presencia de masa abdominal palpable en epigástrico y cuadrante superior izquierdo. En la cabeza se observaron zonas alopécicas. Discusión: El 90% de los tricobezoares se presentan en el sexo femenino. Su máxima frecuencia es entre 10 y 19 años. El tratamiento de los bezoares, excepto los más pequeños, es quirúrgico. El control psiquiátrico postoperatorio es fundamental ya que en casi todos los casos existe en el fondo un conflicto afectivo que perpetúa el hábito de ingerir cabello.

A Trichobezoar is a rare tumoral mass of the gastrointestinal tract, formed mainly from the ingestion of hair. It contains also mucus and foods debris. Case presentation: A 22 years old female with a 10 years history of surgery secondary to gastric foreign body (trichobezoar), presents with abdominal pain, swelling, nausea and vomiting. Physical examination of the abdomen revealed a palpable mass in the epigastric and left upper quadrant regions. It was also noted areas of alopecia of the scalp. Discussion: Ninety percent of the trichobezoars present in females with a high frequency between 10 - 19 years. The treatment of bezoars (unless small in size) is mainly surgical. A psychiatric evaluation and follow up is important after surgery hence in most cases there is a psychological disorder that lead to the ingestion of hair.

Risk factors associated with the development of hyperamylasemia and post-ERCP pancreatitis in the Cuban National Institute.

CONTEXT: Acute pancreatitis is the most common complication in ERCP, and some risk factors were associated with the development of hyperamylasemia and post-ERCP pancreatitis. OBJECTIVES: identifying new factors associated with the development of hyperamylasemia or post-ERCP pancreatitis in patients attended at our center. MATERIAL AND METHODS: A (retrospective) cohort study was carried out in 170 patients on which a diagnostic-therapeutic ERCP was done due to biliopancreatic disease. 67 patients developed hyperamylasemia (39.4%) and 6 post-ERCP pancreatitis (3.5%). The following diagnostic criteria were applied: Hyperamylasemia: increase in the serum amylase level above the normal value (90 I/U). Acute post-ERCP pancreatitis: clinical: continuous abdominal pain for over 24 hours and biochemical: elevation of amylase3 times above normal value (90 U/I). RESULTS: The number of cannulations more than 4 (19 patients), (p=0.006; RR= 3.00) was associated significantly with the development of hyperamylasemia and the placing of biliary stent (14 patients), (p=0.00; RR= 0.39) was a protective factor. The factors associated with the development of post-ERCP pancreatitis were related with the patient (peridiverticular location of the papilla (p=0.00; RR= 2.00) and the sphincter of Oddi dysfunction (p=0.000; RR=1.20). CONCLUSION: Technical factors were associated with the development of hyperamylasemia, however, the factors associated with the development of post-ERCP pancreatitis in our universe of study were related mainly with the patient.

[Bouveret Syndrome. First case diagnosed in Santa Maria del Socorro, Ica, Peru]. / Síndrome de Bouveret. Primer caso diagnosticado en el Hospital Santa María del Socorro, Ica, Perú

We are presenting an case of a patient with upper gastrointestinal bleeding presented as hematemesis preceded by profuse vomiting secondary to a duodenal obstruction, caused by an impacted giant biliary stone in the duodenal bulb (Bouveret syndrome). The diagnosis was made during an upper gastrointestinal endoscopy and confirmed by surgery. We report and discuss this case as it is the first presentation in our institution.

Risk factors associated with the development of hyperamylasemia and post-ERCP pancreatitis in the Cuban National Institute / Factores de riesgo con el desarrollo de la hiperamilasemia y pancreatitis post PCRE en el Cuban National Institute

Contexto: La pancreatitis aguda es la complicación más frecuente de la PCRE y algunos factores de riesgo son asociados con el desarrollo de hiperamilasemia y pancreatitis post PCRE. Objetivos: Identificar factores nuevos asociados con hiperamilasemia y pancreatitis post PCRE en pacientes que acudieron a nuestro centro. Material y métodos: Un estudio retrospectivo de cohorte se llevó a cabo en 170 pacientes en quienes se realizó una CPRE diagnóstico-terapéutica por enfermedad biliopancreática. 67 pacientes desarrollaron hiperamilasemia (39,4%) y 6 pancreatitis post PCRE (3,5%). Se aplicaron los siguientes criterios diagnósticos: Hiperamilasemia: elevación de la amilasa sérica por encima del valor normal (90IU).Pancreatitis aguda post PCRE: dolor abdominal continuo por más de 24 horas y elevación de la amilasa tres veces por encima del valor normal. Resultados: El número de canulaciones, más de 4 (19 pacientes), (p=0,006; RR= 3,00) se asoció significativamente con el desarrollo de la hiperamilasemia y la puesta de stents biliares (14 pacientes) se asoció como un factor protector (p=0,00; RR= 0,39). Los factores asociados con el desarrollo de la pancreatitis post PCRE se relacionaron con el paciente (localización peridiverticular de la papila (p=0,00; RR= 2,00) y disfunción del Esfinter de Oddi (p=0,000; RR=1,20). Conclusiones: Factores técnicos fueron asociados con el desarrollo de la hiperamilasemia, sin embargo, los relacionados con el desarrollo de la pancreatitis post PCRE fueron mayoritariamente relacionados al paciente.

Context: Acute pancreatitis is the most common complication in ERCP, and some risk factors were associated with the development of hyperamylasemia and post-ERCP pancreatitis. Objectives: identifying new factors associated with the development of hyperamylasemia or post-ERCP pancreatitis in patients attended at our center. Material and methods: A (retrospective) cohort study was carried out in 170 patients on which a diagnostic-therapeutic ERCP was done due to biliopancreatic disease. 67 patients developed hyperamylasemia (39.4%) and 6 post-ERCP pancreatitis (3.5%). The following diagnostic criteria were applied: Hyperamylasemia: increase in the serum amylase level above the normal value (90I/U). Acute post-ERCP pancreatitis: clinical: continuous abdominal pain for over 24 hours and biochemical: elevation of amylase 3 times above normal value (90U/I). Results: The number of cannulations more than 4 (19 patients), (p=0.006; RR= 3.00) was associated significantly with the development of hyperamylasemia and the placing of biliary stent (14 patients), (p=0.00; RR= 0.39) was a protective factor. The factors associated with the development of post-ERCP pancreatitis were related with the patient (peridiverticular location of the papilla (p=0.00; RR= 2.00) and the sphincter of Oddi dysfunction (p=0.000; RR=1.20). Conclusion: Technical factors were associated with the development of hyperamylasemia, however, the factors associated with the development of post-ERCP pancreatitis in our universe of study were related mainly with the patient.

Síndrome de Bouveret. Primer caso diagnosticado en el Hospital Santa María del Socorro, Ica, Perú / Bouveret Syndrome. First case diagnosed in Santa Maria del Socorro, Ica, Peru

Se presenta un caso de paciente con sangrado digestivo alto en forma de hematemesis precedido de vómitos profusos secundarios a obstrucción duodenal, causada por un cálculo gigante impactado en el bulbo duodenal (síndrome de Bouveret). El diagnóstico se realizó mediante video-endoscopía digestiva alta y se confirmó en el acto operatorio. Se presenta y discute el caso al reportarse por primera vez en nuestra institución.

We are presenting an case of a patient with upper gastrointestinal bleeding presented as hematemesis preceded by profuse vomiting secondary to a duodenal obstruction, caused by an impacted giant biliary stone in the duodenal bulb (Bouveret syndrome). The diagnosis was made during an upper gastrointestinal endoscopy and confirmed by surgery. We report and discuss this case as it is the first presentation in our institution.

Chromoendoscopy with red phenol in the diagnosis of Helicobacter pylori infection.

An analytic study to validate a diagnostic test was carried out at the Institute of Gastroenterology in Havana, Cuba in adult patients of both sexes in whom chromoendoscopy was carried out with red phenol at 0.1% over the gastric mucosa for the detection of Helicobacter pylori infection between November 2008 and December 2010. The staining with red phenol at 0.1% is included in the invasive tests for the diagnosis of Helicobacter pylori infection and of the reactive techniques. The sensibility of red phenol dye in the diagnosis of Helicobacter pylori infection in the patients studied was of 72.6% with a confidence interval (C.I.) of 95% (64.9 to 79.2%) and a specificity of 75.5% C.I. 95% (61.9 to 85.4%). The positive predictive value was of 89.8% C.I. 95% (83.1 to 94.1%) and the negative predictive value of 48.1% C.I. 95% (37.3 to 59.0%). The proportion of false positives was of 24.5% C.I. 95% (14.6 to 38.1%)and the proportion of false negatives was of 27.4% C.I. 95% (20.8 to 35.1%). The diagnostic accuracy of the dye on the patients studied was 73.3% C.I. 95% (66.7 to 79.0%). The diagnostic odds ratio was 8.17 C.I. 95% (3.88 to 17.23), the J Youden ratio of 0.5 and the Kappa coefficient of 0.40 C.I. 95% (0.27 to 0.54). The staining dye with red phenol at 0.1% resulted in a useful method in the diagnosis of Helicobacter pylori infection in the gastric mucosa, it can be applied in our environment and has multiple advantages (topographic localization, avoids contamination and fast and immediate reading).

Cromoendoscopia con rojo fenol en el diagnóstico de la infección por Helicobacter pylori / Chromoendoscopy with red phenol in the diagnosis of Helicobacter pylori infection

Se realizó un estudio analítico de validación de prueba diagnóstica a pacientes adultos de ambos sexos, en el Instituto de Gastroenterología de La Habana. Cuba, a los cuales se les realizó cromoendoscopia con rojo fenol al 0,1% sobre la mucosa gástrica para la detección de infección por Helicobacter pylori, entre noviembre de 2008 y diciembre de 2010. La tinción con rojo fenol al 0,1% se encuentra dentro de las pruebas invasivas para la detección de la infección por H. pylori y de las llamadas técnicas reactivas. La sensibilidad de la tinción con rojo fenol en el diagnóstico de la infección por Helicobacter pylori en los pacientes estudiados fue del 72,6%. IC 95% (64,9 a 79,2%) y la especificidad del 75,5%. IC 95% (61,9 a 85.4%). El valor predictivo positivo fue del 89,8%. IC 95% (83,1 a 94,1%) y el valor predictivo negativo del 48,1%. IC 95% (37,3 a 59,0%). La proporción de falsos positivos fue de 24,5%. IC 95% (14,6 a 38,1%) y la proporción de falsos negativos de 27,4%. IC 95% (20,8 a 35,1%). La exactitud diagnóstica de la tinción en los pacientes estudiados fue del 73,3%. IC 95% (66,7 a 79.0%). La odds ratio diagnóstica fue de 8,17 IC 95% (3,88 a 17,23), el índice J de Youden de 0,5 y el índice de Kappa de 0,40 IC 95% (0,27 a 0,54). La tinción con rojo fenol al 0,1% resultó un método útil en el diagnóstico de la infección por Helicobacter pylori en la mucosa gástrica, aplicable en nuestro medio al contar además con múltiples ventajas (localización topográfica, evita contaminación y lectura rápida e inmediata)(AU)

An analytic study to validate a diagnostic test was carried out at the Institute of Gastroenterology in Havana, Cuba in adult patients of both sexes in whom chromoendoscopy was carried out with red phenol at 0.1% over the gastric mucosa for the detection of Helicobacter pylori infection between November 2008 and December 2010. The staining with red phenol at 0.1% is included in the invasive tests for the diagnosis of Helicobacter pylori infection and of the reactive techniques. The sensibility of red phenol dye in the diagnosis of Helicobacter pylori infection in the patients studied was of 72.6% with a confidence interval (C.I.) of 95% (64.9 to 79.2%) and a specificity of 75.5% C.I. 95% (61.9 to 85.4%). The positive predictive value was of 89.8% C.I. 95% (83.1 to 94.1%) and the negative predictive value of 48.1% C.I. 95% (37.3 to 59.0%). The proportion of false positives was of 24.5% C.I. 95% (14.6 to 38.1%) and the proportion of false negatives was of 27.4% C.I. 95% (20.8 to 35.1%). The diagnostic accuracy of the dye on the patients studied was 73.3% C.I. 95% (66.7 to 79.0%). The diagnostic odds ratio was 8.17 C.I. 95% (3.88 to 17.23), the J Youden ratio of 0.5 and the Kappa coefficient of 0.40 C.I. 95% (0.27 to 0.54). The staining dye with red phenol at 0.1% resulted in a useful method in the diagnosis of Helicobacter pylori infection in the gastric mucosa,it can be applied in our environment and has multiple advantages (topographic localization, avoids contamination and fast and immediate reading)(AU)