[Diffuse gastrointestinal angiodysplasia associated with cryptogenic hepatic cirrhosis and coagulopathy simulating von Willebrand disease]. / Angiodisplasia gastrointestinal difusa asociada a cirrosis hepática criptogenética y coagulopatía que simulaba una enfermedad de von Willebrand.

Angiodysplasic lesions can be located anywhere in the gastrointestinal tract, but most of them are found in the cecum and right colon. Angiodysplasias are very infrequent in the stomach and small bowel. These lesions can be associated with several clinical conditions, such as certain coagulation disorders and liver diseases. We report the case of a diffuse gastrointestinal angiodysplasia in a female patient with idiopathic cirrhosis of the liver who developed a coagulopathy which mimicked von Willebrand disease. After repeated blood transfusions, which were not able to control the anemia of the patient, an antrectomy was performed because most lesions were located in the antrum. The procedure did not achieve a suitable control of the bleeding. Finally, a hormonal therapy combining estrogens and progestagens, was able to control, at least partially, the patient's chronic gastrointestinal bleeding.

[Severe massive pseudomembranous colitis with a fulminant course]. / Colitis seudomembranosa grave masiva y de curso fulminante.

Pseudomembranous colitis is an inflammatory disease of rectal and colonic mucosa caused by Clostridium difficile produced toxin. The inflammation is produced as the consequence of a non-specific response to several agents. It usually presents with abdominal pain and mild watery diarrhea which used to decrease when removing the antibiotic or when starting the therapy with metronidazole or vancomycin. In aged patients, with severe concomitant diseases, may appear complications such as dehydration, electrolyte imbalance, hypotension and toxic megacolon, which occasionally may lead to fatal outcome. We report the case of a severe pseudomembranous colitis, with a fulminant clinical course, in a patient without a recent antibiotic therapy.

[Epithelioid hemangioendothelioma: a rare hepatic tumor]. / Hemangioendotelioma epitelioide: Un raro tumor hepático.

We present a case of epithelioid hemangioendothelioma of the liver (EHL). The imaging techniques did not permit the diagnosis. A liver biopsy was done under laparoscopy. One year later, the patient remains without symptoms in spite of the presence of lung metastases and the therapeutic abstention. The most outstanding aspects of this rare hepatic tumor are discussed.

[The endoscopic management of postoperative biliary fistulae]. / Manejo endoscópico de las fístulas biliares postquirúrgicas.

We report a series of 15 patients with a postoperative biliary fistula treated by endoscopic sphincterotomy. The exact location of the bile leak was revealed by ERCP in 13 cases (87%): cystic duct remnant in 6 (39%), intrahepatic biliary tree in 4 (26%), and main bile duct in 3 (20%). In all cases a distal obstacle (ie: retained stones, hydatid material) to bile flow was also found in ERCP. Treatment consisted of endoscopic sphincterotomy and subsequent removal of the distal obstacle, and could be completed in 13 (87%) cases. In our experience the treatment of postoperative biliary fistula with a distal obstruction bile flow by endoscopic sphincterotomy is a safe and effective procedure, and should be recommended as the first option in those patients.