Endoscopic management of pancreatic collections. Endoscopic Ultrasound Group from the Spanish Society of Digestive Endoscopy (GSEED-USE) Clinical Guidelines.

Acute pancreatitis is associated with significant morbidity and mortality. It can develop complications such as fluid collections and necrosis. Infection of necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with organ failure and worse prognosis. In the past years, the treatment of pancreatic collections has shifted from open surgery to minimally invasive techniques, such as endoscopic ultrasound guided drainage. These guidelines from a selection of experts among the Endoscopic Ultrasound Group from the Spanish Society of Gastrointestinal Endoscopy (GSEED-USE) have the purpose to provide advice on the management of pancreatic collections based on a thorough review of the available scientific evidence. It also reflects the experience and clinical practice of the authors, who are advanced endoscopists or clinical pancreatologists with extensive experience in managing patients with acute pancreatitis.

Hipercalcemia sintomática como forma de presentación de un caso de tuberculosis esplénica aislada / Symptomatic hypercalcemia presenting as a case of isolated splenic tuberculosis

Fundamento y objetivo: Describir un cuadro clínico poco habitual como la tuberculosis esplénica aislada. Paciente y método: Presentamos un caso de tuberculosis esplénica aislada, una forma rara de tuberculosis extrapulmonar, en un paciente inmunocompetente, y que, como peculiaridad, comienza en forma de hipercalcemia sintomática. Resultados: Se expone ampliamente el caso clínico y los procedimientos realizados para excluir las patologías que integraron el diagnóstico diferencial. Hacemos énfasis en la utilidad de la punción aspirativa con aguja fina del bazo para la obtención de muestras microbiológicas, y el uso de la reacción en cadena de la polimerasa específica para micobacterias para confirmar el diagnóstico de esta entidad. Igualmente, de acuerdo con otros autores, optamos por un tratamiento médico inicial con antituberculostáticos, reservando la cirugía para los casos refractarios o que se compliquen con rotura esplénica espontánea. Conclusión: La hipercalcemia puede ser una forma de presentación de las enfermedades granulomatosas. La afectación aislada del bazo por micobacterias es una forma poco frecuente de tuberculosis extrapulmonar y más aún en pacientes inmunocompetentes (AU)

Background and objective: To describe an unusual clinical presentation as isolated splenic tuberculosis. Patient and methods: We report a case of isolated splenic tuberculosis, a rare form of extrapulmonary tuberculosis in an immunocompetent patient, and, as a peculiarity, debuts in the form of symptomatic hypercalcemia. Results: We deeply report the clinical case and the procedures performed to exclude other diseases. We emphasize the usefulness of fine needle aspiration of the spleen to obtain microbiological samples, and the use of specific polymerase chain reaction for mycobacterias to establish the definitive diagnosis of this entity. In agreement with other authors, we chose initial medical treatment with antituberculous drugs, reserving surgery for refractory cases or in case of spontaneous splenic rupture. Conclusion: Hypercalcemia can be a presentation of granulomatous diseases. The isolated involvement of the spleen by mycobacterias is a rare form of extrapulmonary tuberculosis and more so in immunocompetent patients (AU)

[Symptomatic hypercalcemia presenting as a case of isolated splenic tuberculosis]. / Hipercalcemia sintomática como forma de presentación de un caso de tuberculosis esplénica aislada.

BACKGROUND AND OBJECTIVE: To describe an unusual clinical presentation as isolated splenic tuberculosis. PATIENT AND METHODS: We report a case of isolated splenic tuberculosis, a rare form of extrapulmonary tuberculosis in an immunocompetent patient, and, as a peculiarity, debuts in the form of symptomatic hypercalcemia. RESULTS: We deeply report the clinical case and the procedures performed to exclude other diseases. We emphasize the usefulness of fine needle aspiration of the spleen to obtain microbiological samples, and the use of specific polymerase chain reaction for mycobacterias to establish the definitive diagnosis of this entity. In agreement with other authors, we chose initial medical treatment with antituberculous drugs, reserving surgery for refractory cases or in case of spontaneous splenic rupture. CONCLUSION: Hypercalcemia can be a presentation of granulomatous diseases. The isolated involvement of the spleen by mycobacterias is a rare form of extrapulmonary tuberculosis and more so in immunocompetent patients.