Utilidad de la ecoendoscopia para la resección endoscópica de los tumores carcinoides duodenales / Utility of echoendoscopy for endoscopic resection of duodenal carcinoid tumors

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Tratamiento coadyuvante con corticoides de la tuberculosis peritoneal / Coadjuvant corticoid treatment of peritoneal tuberculosis

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Enfermedad celiaca en paciente con criterios Roma II de síndrome de intestino irritable / Celiac disease in a patient with Rome II criteria of irritable bowell syndrome

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Recuperación de la peristalsis esofágica en paciente diagnosticada de achalasia / Restoration of peristalsis in the esop hagus of a patient diagnosed of achalasia

Presentamos una paciente con disfagia en la que se realizó un seguimiento clínico y manométrico. Inicialmente se observó un trastorno motor sugerente de espasmo difuso; en controles manométricos posteriores se observó progresión a achalasia vigorosa. La paciente fue tratada con dilatación neumática, obteniéndose una buena respuesta. En manometrías realizadas después del tratamiento se objetivo una recuperación de la peristalsis en cuerpo esofágico distal. El tratamiento precoz y la corta evolución de la enfermedad pueden facilitar la recuperación de la peristalsis en estos casos. Dicha recuperación plantea nuevas dudas acerca de la etiología de la achalasia (AU)

Restoration of peristalsis in the esophagus of a patient diagnosed of achalasia.

We report the case of a patient with dysphagia in whom a clinical and manometric follow-up was carried out. We initially observed a motor disorder of the esophageal spasm type. During manometric follow-up a progression to vigorous achalasia was observed. The patient was treated with pneumatic dilation, which obtained a good response to treatment. In manometries performed after treatment we observed a return of peristalsis in the distal esophageal body. Early treatment and short evolution of disease may allow peristalsis to recover in these cases. Peristalsis recovery casts new doubts on achalasia etiology.

[Mucinous adenocarcinoma of the appendix associated with ovarian tumors and pseudomyxoma peritonei. The difficulty in differential diagnosis]. / Adenocarcinoma mucinoso de apéndice asociado con tumores ováricos y pseudomixoma peritonei. Dificultad en el diagnóstico diferencial.

Mucinous adenocarcinoma of the appendix is rare. If there is a concomitant ovarian tumor to determine the primary might be difficult. Histological features are not always determinant, but there are some macroscopic findings that may suggest an origin in the appendix. We report a case of synchronous tumors in appendix and ovaries with pseudomyxoma peritonei. The patient presented with mass sensation in the right lower quadrant, asthenia, anorexia and weight loss. Abdominal ultrasound and CT scan showed a tumor involving cecum, appendix, terminal ileum and pelvis. Findings on colonoscopy and biopsies were inconclusive. At laparotomy, the tumor compressed appendix, cecum and ascendant colon, terminal ileum, ovaries and peritoneum. Histopathological analysis demonstrated a well-differentiated mucinous adenocarcinoma of appendiceal origin with metastasis in ovaries and peritoneum (pseudomyxoma peritonei).

Adenocarcinoma mucinoso de apéndice asociado con tumores ováricos y pseudomixoma peritonei. Dificultad en el diagnóstico diferencial / Mucinous adenocarcinoma of the appendix associated with ovarian tumor and pseudomyxoma peritonei: a difficult differential diagnosis

El adenocarcinoma mucinoso de apéndice es raro. Si existe un tumor ovárico concomitante, determinar cual es el origen del tumor primario puede ser difícil. Las características histopatológicas no son siempre concluyentes pero hay algunos hallazgos macroscópicos que pueden sugerir que el origen es en el apéndice. Presentamos el caso de tumores sincrónicos en apéndice y ovarios con pseudomixoma peritonei. La paciente presentaba sensación de masa en cuadrante inferior izquierdo con astenia, anorexia y pérdida de peso. En la ecografía abdominal y la TAC se evidenció un tumor que se extendía a ciego, apéndice, ileon terminal y pelvis. Los hallazgos de la colonoscopia y las biopsias no fueron concluyentes. En la laparotomía, el tumor abarcaba apéndice, ciego y cólon ascendente, íleon terminal, ovarios y peritoneo. El examen histológico demostró un adenocarcinoma mucinoso bien diferenciado con metástasis en ovario y peritoneo (pseudomixoma peritonei) (AU)

What predictive parameters best indicate the need for emergent gastrointestinal endoscopy after foreign body ingestion?

Our aim was to determine what parameters may be used to indicate an emergent endoscopy after foreign body (FB) ingestion and to ascertain how often FBs are found endoscopically. Demographic data, gastroesophageal antecedents, clinical and endoscopic data, and complications were obtained. We examined 122 patients endoscopically. The onset of symptoms was immediate after FB ingestion in 93% of patients. Dysphagia was the most frequent symptom (66%), with the pharynx the most frequent location of impaction (71%). Endoscopy confirmed the presence of FBs in 52% of patients. Extraction was performed in 78%. The immediate onset of symptoms, dysphagia, and the absence of pharynx localization of impaction were predictive indicators of a positive FB finding (p < 0.05), with diagnostic sensitivity of 86% and specificity of 63%. Upper endoscopy should be performed in all patients with FB ingestion, even though no FB was found in 48%.

Five-year analysis of endoscopic retrograde cholangiopancreatography in the Hospital del Bierzo.

OBJECTIVES: endoscopic retrograde cholangiopancreatography (ERCP) is a widely available endoscopic modality, that is not without risks, but is no longer limited to tertiary referral centers. We evaluated the procedure in terms of imaging success, overall therapeutic failure, complications and mortality. METHODS: this retrospective study ran from January 1992 to December 1997. The following data were collected: 1) cannulation rate, 2) failure to obtain images of the duct, 3) type of ERCP, 4) overall therapeutic failure rate and stone extraction, 5) overall complication rate, 6) immediate complications, 7) late complications (within the first 30 days), and 8) mortality. RESULTS: of 425 ERCP procedures performed, all data for 393 were obtained and included in the analysis. The cannulation success was 94%. Failure to obtain a suitable image occurred in 10%. ERCP was diagnostic in 60% and therapeutic in 40%. Sphincterotomy was performed in 83% of the patients. The therapeutic failure rate was 15%. Stone extraction was successful in 69%. The overall complication rate was 8.6%; 2.2% of these complications were severe or fatal. Immediate complications occurred in 4% and late complications in 5.9%. Immediate complications were less frequent in diagnostic ERCP (p < 0.01). Late complications were: pancreatitis (3. 5%), bleeding (1.4%), perforation (0.3%) and cholangitis (0.8%). There was no difference in the frequency of severe pancreatitis between the types of ERCP procedure. Bleeding occurred more frequently in sphincterotomy (p < 0.05). The overall mortality rate was 1.6%. CONCLUSIONS: a continuous audit in each endoscopy unit should be performed to improve ERCP procedures. Diagnostic and therapeutic ERCP carry a similar risk of severe pancreatitis. The bleeding rate was higher in therapeutic ERCP and sphincterotomy.