[Gastric pneumatosis and gas in the portal venous system secondary to peptic ulcer]. / Neumatosis gástrica y gas en el sistema venoso portal secundario a una úlcera péptica.

A 72-year-old woman presented to the emergency department with recurrent vomiting without abdominal pain. On physical examination, the patient was afebrile and her abdomen was soft and nontender with a giant abdominal-wall hernia. Upper endoscopy showed a deep, 3-cm ulcer at the gastric angulus. Computed tomography (CT) of the abdomen showed gastric dilatation with gas in the wall and a large part of the digestive tract within the hernia sac. CT imaging also revealed gas throughout the portal venous system. The patient declined surgery. Management was conservative and included correction of fluid and electrolyte balance, and nasogastric drainage for gastric decompression with good response.

Neumatosis gástrica y gas en el sistema venoso portal secundario a una úlcera péptica / Gastric pneumatosis and gas in the portal venous system secondary to peptic ulcer

Presentamos el caso de una mujer de 72 años, que acudió aurgencias tras presentar vómitos de repetición, sin dolor abdominal.En la exploración presentaba una gran hernia abdominalsin datos de complicación, no dolorosa y afebril. Laendoscopia digestiva alta (EDA) mostró una úlcera profundade unos 3 cm de tamaño en la incisura angularis. En latomografía computarizada abdominal se apreció una dilatacióngástrica, con neumatosis de toda la pared y gas en elsistema venoso portal. La paciente rechazó el tratamientoquirúrgico de la hernia abdominal. Se realizó un tratamientoconservador con reposición de volumen y del balanceelectrolítico, y una descompresión gástrica con sonda nasogástrica,con buena respuesta por parte de la paciente

A 72-year-old woman presented to the emergency departmentwith recurrent vomiting without abdominal pain. Onphysical examination, the patient was afebrile and her abdomenwas soft and nontender with a giant abdominal-wallhernia. Upper endoscopy showed a deep, 3-cm ulcer at thegastric angulus. Computed tomography (CT) of the abdomenshowed gastric dilatation with gas in the wall and a largepart of the digestive tract within the hernia sac. CT imagingalso revealed gas throughout the portal venous system.The patient declined surgery. Management was conservativeand included correction of fluid and electrolyte balance, andnasogastric drainage for gastric decompression with goodresponse

[Diagnostic value of colonoscopy indication as predictor of colorectal cancer: is it possible to design a fast track diagnosis?]. / Valor de la indicación de la colonoscopia como predictor de diagnóstico de cáncer colorrectal. Se puede diseñar un circuito rápido de diagnóstico?

BACKGROUND: Diagnostic delay in patients with colorectal cancer (CRC) is a quality indicator and its reduction could improve prognosis of the disease. OBJECTIVE: To analyze the diagnostic value of different colonoscopy indications in CRC and to select the signs or symptoms that, if prioritized in a rapid diagnostic circuit, would be most efficient. MATERIAL AND METHODS: A retrospective analysis of 2219 outpatients who underwent colonoscopy from 2000 to 2007 was performed. For each indication we calculated the sensitivity (S), positive predictive value (PPV), positive likelihood ratio (LR+), and number of colonoscopies needed to diagnose a case of CRC (NND). RESULTS: A total of 179 patients were diagnosed with CRC. The indications with greatest PPV were liver metastases (35.3%), suspicious radiological image (20.8%), and non-distal rectal bleeding (22%). Iron deficiency anemia (11%), constitutional syndrome (10%), any rectal bleeding (9.4%) and rectal syndrome (9%) had intermediate PPV. Constipation (6.3%), alternating constipation-diarrhea (3.3%), changes in bowel habits (3%), distal rectal bleeding (2.1%), diarrhea (1.8%) and abdominal pain (1.1%) had low PPV. The NND was 4 in liver metastases, 7 in non-distal bleeding and 8 in suspicious radiological image. Distal bleeding (13), diarrhea (14), abdominal pain (14), changes in bowel habits (15) and alternating constipation-diarrhoea (21) had negative NND. The subgroup of patients aged >or= 50 years showed lower NND in non-distal rectal bleeding (5), suspicious radiological image (5) and any rectal bleeding (16). CONCLUSIONS: Patients with non-distal rectal bleeding should be prioritized over other indications in a strategy of rapid diagnosis of CRC. Age equal to or more than 50 years should also be considered because this factor seems to reduce NND. Distal bleeding, abdominal pain and changes in bowel habits had low PPV and were associated with other diagnoses than CRC. Consequently, prioritization of these factors would be inefficient.

Valor de la indicación de la colonoscopia como predictor de diagnóstico de cáncer colorrectal. ¿Se puede diseñar un circuito rápido de diagnóstico? / Diagnostic value of colonoscopy indication as predictor of colorectal cancer: Is possible to be designed a fast tracking for diagnosis?

INTRODUCCIÓN: La demora diagnóstica en los pacientes concáncer colorrectal (CCR) es un indicador de calidad, y su reducciónpuede suponer un beneficio en el pronóstico de la enfermedad.OBJETIVOS: Analizar el valor diagnóstico para CCR de las indicacionesde colonoscopia y seleccionar aquellas cuya priorizaciónen un circuito rápido de diagnóstico es más eficiente.MATERIAL Y MÉTODOS: Análisis retrospectivo de 2.219 colonoscopiasambulatorias de 2000 a 2007. Para cada indicaciónse calcularon la sensibilidad (S), el valor predictivo positivo(VPP), el cociente de probabilidad positivo (LR+) y el númerode colonoscopias para diagnosticar un caso de CCR (NND).RESULTADOS: Fueron diagnosticados de CCR 179 pacientes.Las indicaciones con mayor VPP fueron las metástasis hepáticas(35,3%), la imagen radiológica sospechosa (20,8%) y larectorragia no distal (22%). La anemia ferropénica (11%), elsíndrome constitucional (10%), cualquier rectorragia (9,4%)y el síndrome rectal (9%) tuvieron un VPP intermedio. El estreñimiento(6,3%), la alternancia estreñimiento-diarrea(3,3%), la alteración del hábito intestinal (3%), la rectorragiadistal (2,1%), la diarrea (1,8%) y el dolor abdominal (1,1%)presentaron un VPP bajo. El NND fue de 4 en las metástasis,de 7 en la rectorragia no distal y de 8 en la imagen radiológicasospechosa, mientras que la rectorragia distal (–13), la diarrea(–14), el dolor abdominal (–14), la alteración del hábitointestinal (–15) y la alternancia (–21) tuvieron NND negativos.Los pacientes con una edad 50 años mostraron menorNND en la rectorragia no distal (5), la imagen radiológica sospechosa(5) y cualquier rectorragia (16).(..) (AU)

BACKGROUND: Diagnostic delay in patients with colorectalcancer (CRC) is a quality indicator and its reduction couldimprove prognosis of the disease.OBJECTIVE: To analyze the diagnostic value of different colonoscopyindications in CRC and to select the signs or symptomsthat, if prioritized in a rapid diagnostic circuit, wouldbe most efficient.MATERIAL AND METHODS: A retrospective analysis of 2219outpatients who underwent colonoscopy from 2000 to 2007was performed. For each indication we calculated the sensitivity(S), positive predictive value (PPV), positive likelihoodratio (LR+), and number of colonoscopies needed to diagnosea case of CRC (NND).RESULTS: A total of 179 patients were diagnosed with CRC.The indications with greatest PPV were liver metastases(35.3%), suspicious radiological image (20.8%), and non-distalrectal bleeding (22%). Iron deficiency anemia (11%),constitutional syndrome (10%), any rectal bleeding (9.4%)and rectal syndrome (9%) had intermediate PPV. Constipation(6.3%), alternating constipation-diarrhea (3.3%), changesin bowel habits (3%), distal rectal bleeding (2.1%), diarrhea(1.8%) and abdominal pain (1.1%) had low PPV. TheNND was 4 in liver metastases, 7 in non-distal bleeding and8 in suspicious radiological image. Distal bleeding (–13),diarrhea (–14), abdominal pain (–14), changes in bowel habits(–15) and alternating constipation-diarrhoea (–21) hadnegative NND. The subgroup of patients aged 50 yearsshowed lower NND in non-distal rectal bleeding (5), suspiciousradiological image (5) and any rectal bleeding (16). (..) (AU)

Valor de la indicación de la colonoscopia como predictor de diagnóstico de cáncer colorrectal. ¿Se puede diseñar un circuito rápido de diagnóstico? / Diagnostic value of colonoscopy indication as predictor of colorectal cancer: is possible to be designed a fast tracking for diagnosis?

INTRODUCCIÓN: La demora diagnóstica en los pacientes concáncer colorrectal (CCR) es un indicador de calidad, y su reducciónpuede suponer un beneficio en el pronóstico de la enfermedad.OBJETIVOS: Analizar el valor diagnóstico para CCR de las indicacionesde colonoscopia y seleccionar aquellas cuya priorizaciónen un circuito rápido de diagnóstico es más eficiente.MATERIAL Y MÉTODOS: Análisis retrospectivo de 2.219 colonoscopiasambulatorias de 2000 a 2007. Para cada indicaciónse calcularon la sensibilidad (S), el valor predictivo positivo(VPP), el cociente de probabilidad positivo (LR+) y el númerode colonoscopias para diagnosticar un caso de CCR (NND).RESULTADOS: Fueron diagnosticados de CCR 179 pacientes.Las indicaciones con mayor VPP fueron las metástasis hepáticas(35,3%), la imagen radiológica sospechosa (20,8%) y larectorragia no distal (22%). La anemia ferropénica (11%), elsíndrome constitucional (10%), cualquier rectorragia (9,4%)y el síndrome rectal (9%) tuvieron un VPP intermedio. El estreñimiento(6,3%), la alternancia estreñimiento-diarrea(3,3%), la alteración del hábito intestinal (3%), la rectorragiadistal (2,1%), la diarrea (1,8%) y el dolor abdominal (1,1%)presentaron un VPP bajo. El NND fue de 4 en las metástasis,de 7 en la rectorragia no distal y de 8 en la imagen radiológicasospechosa, mientras que la rectorragia distal (–13), la diarrea(–14), el dolor abdominal (–14), la alteración del hábitointestinal (–15) y la alternancia (–21) tuvieron NND negativos.Los pacientes con una edad >= 50 años mostraron menorNND en la rectorragia no distal (5), la imagen radiológica sospechosa(5) y cualquier rectorragia (16).CONCLUSIONES: En una estrategia de diagnóstico rápido deCCR, los casos de rectorragia no distal deberían priorizarsesobre el resto de indicaciones de colonoscopia. La edad >= 50años debe tenerse en cuenta, ya que disminuye el NND. Larectorragia distal, el dolor abdominal y la alteración del hábitointestinal tuvieron bajos VPP, por lo que su priorizaciónresulta ineficiente

BACKGROUND: Diagnostic delay in patients with colorectalcancer (CRC) is a quality indicator and its reduction couldimprove prognosis of the disease.OBJECTIVE: To analyze the diagnostic value of different colonoscopyindications in CRC and to select the signs or symptomsthat, if prioritized in a rapid diagnostic circuit, wouldbe most efficient.MATERIAL AND METHODS: A retrospective analysis of 2219outpatients who underwent colonoscopy from 2000 to 2007was performed. For each indication we calculated the sensitivity(S), positive predictive value (PPV), positive likelihoodratio (LR+), and number of colonoscopies needed to diagnosea case of CRC (NND).RESULTS: A total of 179 patients were diagnosed with CRC.The indications with greatest PPV were liver metastases(35.3%), suspicious radiological image (20.8%), and non-distalrectal bleeding (22%). Iron deficiency anemia (11%),constitutional syndrome (10%), any rectal bleeding (9.4%)and rectal syndrome (9%) had intermediate PPV. Constipation(6.3%), alternating constipation-diarrhea (3.3%), changesin bowel habits (3%), distal rectal bleeding (2.1%), diarrhea(1.8%) and abdominal pain (1.1%) had low PPV. TheNND was 4 in liver metastases, 7 in non-distal bleeding and8 in suspicious radiological image. Distal bleeding (–13),diarrhea (–14), abdominal pain (–14), changes in bowel habits(–15) and alternating constipation-diarrhoea (–21) hadnegative NND. The subgroup of patients aged >= 50 yearsshowed lower NND in non-distal rectal bleeding (5), suspiciousradiological image (5) and any rectal bleeding (16). CONCLUSIONS: Patients with non-distal rectal bleeding shouldbe prioritized over other indications in a strategy of rapiddiagnosis of CRC. Age equal to or more than 50 years shouldalso be considered because this factor seems to reduce NND.Distal bleeding, abdominal pain and changes in bowel habitshad low PPV and were associated with other diagnoses thanCRC. Consequently, prioritization of these factors would be inefficient

Hepatitis aguda colestásica inducida por amoxicilina-clavulánico / Acute cholestatic hepatitis induced by amoxicillin-clavulanic acid

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