ABSTRACT
Initially developed as medications for diabetes mellitus, GLP-1 agonists have gained much popularity in the treatment of obesity and weight loss. The present case describes a 69-year-old woman with a history of peptic ulcer and use of NSAIDs, who presented with abdominal pain and oral intolerance refractory to conventional management, for which an upper digestive endoscopy was performed, diagnosing severe gastroparesis. Asking more about the story, revealed surreptitious use of semaglutide. She continued with supportive therapy and the symptoms resolved spontaneously. The present case report aims to warn of the potential risks of the use of GLP-1 analogues in the context of endoscopy with sedation.
Subject(s)
Gastroparesis , Glucagon-Like Peptide-1 Receptor , Glucagon-Like Peptides , Weight Loss , Humans , Aged , Female , Glucagon-Like Peptide-1 Receptor/agonists , Glucagon-Like Peptides/therapeutic use , Glucagon-Like Peptides/analogs & derivatives , Glucagon-Like Peptides/adverse effects , Weight Loss/drug effects , Gastroparesis/drug therapy , Severity of Illness Index , Glucagon-Like Peptide-1 Receptor AgonistsABSTRACT
Inflammatory bowel disease (IBD) is a spectrum of chronic immune-mediated diseases that affect the gastrointestinal tract and other extraintestinal systems, behaving as a systemic disease. Thromboembolic phenomena are a frequent complication in IBD, because of hypercoagulability states associated with disease activity, and their presence has a negative impact on prognosis and patient survival. Due to this, the control of the inflammatory activity of IBD is one of the pillars in the control of thromboembolic events. Biological drugs are associated with rapid control of the inflammatory process, however, the security profile for the reactivation of latent infections, particularly tuberculosis, is always discussed. We present the case of a 37-year-old patient who presented with deep vein thrombosis in the left lower limb and later with massive pulmonary thromboembolism. During his evaluation, he was diagnosed with Crohn's disease (CD). When carrying out the studies prior to the use of biologics, PPD and quantiferon tests were positive. After discussing the case, we decided to start treatment with ustekinumab.
Subject(s)
Crohn Disease , Inflammatory Bowel Diseases , Latent Tuberculosis , Pulmonary Embolism , Thromboembolism , Male , Humans , Adult , Crohn Disease/complications , Crohn Disease/drug therapy , Ustekinumab/therapeutic use , Latent Tuberculosis/complications , Latent Tuberculosis/diagnosis , Latent Tuberculosis/drug therapy , Inflammatory Bowel Diseases/drug therapy , Thromboembolism/complications , Thromboembolism/drug therapy , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Pulmonary Embolism/drug therapyABSTRACT
La enfermedad inflamatoria intestinal (EII) es un espectro de enfermedades crónicas inmunomediadas que afectan tanto el tracto gastrointestinal, como otros sistemas extraintestinales, comportándose como una enfermedad sistémica. Los fenómenos tromboembólicos son una complicación frecuente en la EII, como consecuencia de los estados de hipercoagulabilidad que se asocian con la actividad de la enfermedad, y su aparición tiene un impacto negativo tanto en el pronóstico como en la sobrevida de los pacientes. Debido a ello, el control de la actividad inflamatoria de la EII es uno de los pilares en el control de los eventos tromboembólicos. Los medicamentos biológicos se asocian al control rápido del cuadro inflamatorio, sin embargo, siempre se discute el tema de seguridad para la reactivación de infecciones latentes, en particular tuberculosis. Presentamos el caso de un paciente de 37 años que debutó con trombosis venosa profunda en el miembro inferior izquierdo y posteriormente con tromboembolismo pulmonar masivo. Luego de investigar la etiología y ampliar la historia clínica se le diagnosticó Enfermedad de Crohn (EC). Al realizar los estudios previos al uso de biológicos, las pruebas de PPD y quantiferon resultaron positivas, luego de la discusión del caso se decidió iniciar tratamiento con ustekinumab.
Inflammatory bowel disease (IBD) is a spectrum of chronic immune-mediated diseases that affect the gastrointestinal tract and other extraintestinal systems, behaving as a systemic disease. Thromboembolic phenomena are a frequent complication in IBD, because of hypercoagulability states associated with disease activity, and their presence has a negative impact on prognosis and patient survival. Due to this, the control of the inflammatory activity of IBD is one of the pillars in the control of thromboembolic events. Biological drugs are associated with rapid control of the inflammatory process, however, the security profile for the reactivation of latent infections, particularly tuberculosis, is always discussed. We present the case of a 37-year-old patient who presented with deep vein thrombosis in the left lower limb and later with massive pulmonary thromboembolism. During his evaluation, he was diagnosed with Crohn's disease (CD). When carrying out the studies prior to the use of biologics, PPD and quantiferon tests were positive. After discussing the case, we decided to start treatment with ustekinumab.
ABSTRACT
La obesidad es una patología de importancia a nivel mundial porque conlleva a una alta carga de mortalidad y morbilidad. El balón intragástrico representa una técnica no quirúrgica empleada cada vez con más frecuencia para lograr pérdida de peso. Si bien, este se considera un método seguro, se han reportado algunas complicaciones desde náuseas y vómitos, hasta eventos adversos graves, tales como perforación. La pancreatitis aguda constituye una complicación muy rara del balón intragástrico y se atribuye su efecto a la compresión directa que ejerce sobre el páncreas. Presentamos el caso de una paciente mujer de 21 años, quien después de 7 meses de colocación de balón intragástrico, cursó con dolor abdominal, náuseas y vómitos, asociados a elevación de enzimas pancreáticas. Se hizo diagnóstico de pancreatitis aguda y se corroboró compresión de la cola del páncreas mediante estudio tomográfico. Se decidió retiro del balón mediante endoscopía, cursando luego con evolución favorable.
Obesity is a pathology of importance worldwide because it leads to a high burden of mortality and morbidity. The intragastric balloon represents a non-surgical technique used more and more frequently to achieve weight loss. Although this is considered a safe method, some complications have been reported, from nausea and vomiting to serious adverse events, such as perforation. Acute pancreatitis is a very rare complication of the intragastric balloon, and its effect is attributed to the direct compression it exerts on the pancreas. We present the case of a 21-year-old female patient who, after 7 months of intragastric balloon placement, developed abdominal pain, nausea, and vomiting, associated with elevated pancreatic enzymes. A diagnosis of acute pancreatitis was made and compression of the tail of the pancreas was confirmed by tomographic study. It was decided to remove the balloon by endoscopy, which then progressed favorably.
ABSTRACT
Pneumobilia is a phenomenon associated with the presence of a biliary-enteric fistula or manipulation of the bile duct during procedures or surgical interventions that cause dysfunction of the sphincter of Oddi. A known, but infrequently reported event, is the increase in intraabdominal pressure after closed abdominal trauma, which causes pneumobilia due to a mechanism of retrograde air leakage towards the bile duct. Depending on the general compromise of each patient, the prognosis can vary from a benign condition that only requires conservative management, to being life threatening. We present the case of a 75-year-old male patient who, after suffering a closed thoraco-abdominal trauma, presented with rib fracture and, in addition, gallbladder wall rupture, pneumoperitoneum, pneumobilia, and pneumowirsung, having a favorable clinical course after receiving conservative management.
La neumobilia es un fenómeno asociado a presencia de fístula bilioentérica o manipulación de la vía biliar durante procedimientos o intervenciones quirúrgicas que condicionan disfunción del esfínter de Oddi. Un evento poco reportado, pero ya conocido, es el aumento de la presión intraabdominal tras un trauma abdominal cerrado, que condiciona neumobilia por un mecanismo retrógrado de fuga de aire hacia la vía biliar. Según el compromiso general de cada paciente, el pronóstico puede variar desde un cuadro benigno, que solo requiere un manejo conservador, hasta ser amenazante para la vida. Se presenta el caso de un paciente varón de 75 años, quien después de presentar un trauma toracoabdominal cerrado cursa con fractura costal y, además, ruptura de pared vesicular, neumoperitoneo, neumobilia, y neumowirsung, cursando con evolución favorable tras recibir manejo conservador.
