Colocolic intussusception by lipoma in transverse colon. A cause of intestinal obstruction.

Lipomas in the colon usually present as sessile polypoid masses, rarely pedunculated, with variable dimensions. They are generally asymptomatic and diagnosed incidentally although occasionally they may debut with symptoms. We present the case of a 48-year-old male with intestinal obstruction secondary to colonic lipoma causing invagination at the level of the transverse colon.

Intestinal obstruction due to bariolith impaction.

"Bariolith" is defined as the concretion of barium sulfate in the intestine after performing a radiological study with said contrast. Complications derived from the use of barium are exceptional, but appendicitis, intussusception, volvulus, ulceration, ischemia and perforation have been described. We present the case of a 62 years old woman, who underwent a EGD exploration on the 15th of January 2021 as a part of her study for suspected GERD.

Autophagy in Viral Development and Progression of Cancer.

Autophagy is a complex degradative process by which eukaryotic cells capture cytoplasmic components for subsequent degradation through lysosomal hydrolases. Although this catabolic process can be triggered by a great variety of stimuli, action in cells varies according to cellular context. Autophagy has been previously linked to disease development modulation, including cancer. Autophagy helps suppress cancer cell advancement in tumor transformation early stages, while promoting proliferation and metastasis in advanced settings. Oncoviruses are a particular type of virus that directly contribute to cell transformation and tumor development. Extensive molecular studies have revealed complex ways in which autophagy can suppress or improve oncovirus fitness while still regulating viral replication and determining host cell fate. This review includes recent advances in autophagic cellular function and emphasizes its antagonistic role in cancer cells.

KSHV G-protein coupled receptor vGPCR oncogenic signaling upregulation of Cyclooxygenase-2 expression mediates angiogenesis and tumorigenesis in Kaposi's sarcoma.

Kaposi's sarcoma-associated herpesvirus (KSHV) vGPCR is a constitutively active G protein-coupled receptor that subverts proliferative and inflammatory signaling pathways to induce cell transformation in Kaposi's sarcoma. Cyclooxygenase-2 (COX-2) is an inflammatory mediator that plays a key regulatory role in the activation of tumor angiogenesis. Using two different transformed mouse models and tumorigenic full KSHV genome-bearing cells, including KSHV-Bac16 based mutant system with a vGPCR deletion, we demostrate that vGPCR upregulates COX-2 expression and activity, signaling through selective MAPK cascades. We show that vGPCR expression triggers signaling pathways that upregulate COX-2 levels due to a dual effect upon both its gene promoter region and, in mature mRNA, the 3'UTR region that control mRNA stability. Both events are mediated by signaling through ERK1/2 MAPK pathway. Inhibition of COX-2 in vGPCR-transformed cells impairs vGPCR-driven angiogenesis and treatment with the COX-2-selective inhibitory drug Celecoxib produces a significant decrease in tumor growth, pointing to COX-2 activity as critical for vGPCR oncogenicity in vivo and indicating that COX-2-mediated angiogenesis could play a role in KS tumorigenesis. These results, along with the overexpression of COX-2 in KS lesions, define COX-2 as a potential target for the prevention and treatment of KSHV-oncogenesis.

Regulation of the Expression of Heme Oxygenase-1: Signal Transduction, Gene Promoter Activation, and Beyond.

Significance: Heme oxygenase-1 (HO-1) is a ubiquitous 32-kDa protein expressed in many tissues and highly inducible. They catalyze the degradation of the heme group and the release of free iron, carbon monoxide, and biliverdin; the latter converted to bilirubin by biliverdin reductase. Its role in the regulation of cellular homeostasis is widely documented. Studying regulation of HO-1 expression is important not only to understand the life of healthy cells but also the unbalances in cell metabolism that lead to disease. Recent Advances: The regulation of its enzymatic activity depends heavily upon changes in expression studied mainly at the transcriptional level. Current knowledge regarding HO-1 gene expression focuses primarily on transcription factors such as Nrf2 (nuclear factor erythroid 2-related factor 2), AP-1 (activator protein-1), and hypoxia-inducible factor, which collect signal transduction pathway information at the HO-1 gene promoter. Understanding of gene expression regulation is not limited to transcription factor activity but also involves an extended range of post- or cotranscriptional regulated events. Critical Issues: In addition to the regulation of gene promoter activity, alternative splicing, alternative polyadenylation, and regulation of messenger RNA stability play critical roles in changes in HO-1 gene expression levels, involving specific factors, proteins, and microRNAs. All potential targets for diagnosis or treatment of diseases are related to HO-1 dysregulation. Future Directions: Unbalances in the tightly regulated gene expression mechanisms lead to cell transformation and cancer development. Knowledge of these events and signal transduction cascades triggered by oncogenes in which HO-1 plays a critical role is of upmost importance for research in this field.

Nutrición enteral por yeyunostomía como causa de perforación y necrosis intestinal / Enteral feeding via jejunostomy as a cause of intestinal perforation and necrosis

Introducción: la yeyunostomía de alimentación es una excelente manera de nutrir por vía enteral a pacientes que no pueden tolerar dieta oral con una tasa de complicaciones baja. Se utiliza comúnmente una sonda de Foley, tubo de Ryle, de Kerh o catéter con aguja (Jejuno-Cath®). Caso clínico: presentamos el caso de un paciente varón de 80 años que presentó una perforación intestinal como consecuencia de la nutrición a través de un yeyunocath en el postoperatorio de una gastrectomía subtotal con reconstrucción en Y de Roux, y de otro paciente varón de 53 años con perforación gástrica y múltiples complicaciones postoperatorias, entre ellas, necrosis de un segmento de intestino delgado por impactación de nutrición enteral. Discusión: revisamos la literatura existente sobre esta rara complicación (AU)

Jejunostomy for enteral feeding is excellent for patients who cannot manage oral intake, with a low complication rate. A Foley catheter, Ryle tube, Kerh tube or needle-catheter (Jejuno-Cath®) are commonly used. It is a safe procedure but it can lead to severe complications. We present two cases: firstly, an 80 year old male who was admitted to the Emergency Room with a bowel perforation secondary to Jejuno-Cath® for enteral feeding after a subtotal gastrectomy with Roux-en-Y reconstruction; and secondly, a 53 year old male who was admitted to the Emergency Room due to gastric perforation developing multiple complications, including bowel necrosis and enteral feeding impaction. We have reviewed the recent literature with regard to this rare complication (AU)

Pancreatectomía central en el tratamiento de lesión pancreática benigna. Presentación de un caso y revisión de la literatura / Central pancreatectomy for the treatment of a benign pancreatic lesion. Case report and literature review

Presentamos el caso de una mujer de 45 años diagnosticada incidentalmente de lesión quística pancreática compatible con cistoadenoma seroso de 14 mm. Tras cinco años de seguimiento (TAC y RM) la lesión triplicó su tamaño y se indicó la intervención. Teniendo en cuenta la probable benignidad de la lesión, y en un intento de preservar tanto el bazo como la mayor cantidad posible de parénquima pancreático, se realizó una pancreatectomía central con derivación del remanente distal. Se revisa la literatura nacional e internacional publicada (AU)

We present the case of a 45 year old female patient with an incidental diagnosis of a cystic pancreatic lesion corresponding to a serous cystadenoma of 14 mm. During a 5-year follow-up (CT and MRT) the lesion tripled in size and a surgical intervention was decided upon. The lesion was thought to have a benign pathology and, in an attempt to preserve the spleen and a major portion of pancreatic tissue, a central pancreatectomy with a diversion of the remaining distal pancreas was carried out. The authors reviewed national and international publications (AU)

Bilioescroto secundario a bilioma retroperitoneal como presentación extremadamente rara de fuga biliar espontánea / Biliscrotum secondary to retroperitoneal biloma, as an extremely rare presentation of spontaneous bile leak

Objetivo. Presentar el segundo caso descrito en la bibliografía de bilioescroto secundario a bilioma retroperitoneal espontáneo y mostrar a su vez de manera escalonada el tratamiento que se le suministró hasta la resolución completa del cuadro. Caso clínico: Varón de 69 años que debutó con dolor escrotal derecho en relación con bilioescroto secundario a bilioma retroperitoneal espontáneo. Discusión: El bilioma retroperitoneal es un hecho poco habitual; generalmente se debe a complicaciones quirúrgicas o de procedimientos invasivos (intervencionismo radiológico, CPRE y esfinterotomía endoscópica), aunque puede ser consecuencia de roturas espontáneas de la vesícula o la vía biliar principal. La bilis en el retroperitoneo puede discurrir hasta el escroto, originando la rara entidad conocida como bilioescroto. Generalmente se presenta simulando una hernia inguinal incarcerada. No existe un manejo estandarizado de esta patología ya que está escasamente descrita.

Objective: To present the second case described in the literature of biliscrotum secondary to spontaneous retroperitoneal biloma and show a sequential treatment that we provided until complete resolution. Clinical case: We report the case of a man 69 years old, who debuted with right scrotal pain related to biliscrotum secondary to spontaneous retroperitoneal biloma. Discussion: The retroperitoneal biloma is a rare event, usually due to surgical or invasive procedures complications (radiological interventionism, ERCP and endoscopic sphincterotomy), although it may be the result of spontaneous rupture of the gallbladder or bile duct. Bile in the retroperitoneum may extend into the scrotum, causing the rare condition known as biliscrotum. Usually it occurs simulating an incarcerated inguinal hernia. Does not exist a standardized management of this condition because is poorly described.

Enteral feeding via jejunostomy as a cause of intestinal perforation and necrosis.

Jejunostomy for enteral feeding is excellent for patients who cannot manage oral intake, with a low complication rate. A Foley catheter, Ryle tube, Kerh tube or needle-catheter (Jejuno-Cath®) are commonly used. It is a safe procedure but it can lead to severe complications. We present two cases: firstly, an 80 year old male who was admitted to the Emergency Room with a bowel perforation secondary to Jejuno-Cath® for enteral feeding after a subtotal gastrectomy with Roux-en-Y reconstruction; and secondly, a 53 year old male who was admitted to the Emergency Room due to gastric perforation developing multiple complications, including bowel necrosis and enteral feeding impaction. We have reviewed the recent literature with regard to this rare complication.

Central pancreatectomy for the treatment of a benign pancreatic lesion. Case report and literature review.

We present the case of a 45 year old female patient with an incidental diagnosis of a cystic pancreatic lesion corresponding to a serous cystadenoma of 14 mm. During a 5-year follow-up (CT and MRT) the lesion tripled in size and a surgical intervention was decided upon. The lesion was thought to have a benign pathology and, in an attempt to preserve the spleen and a major portion of pancreatic tissue, a central pancreatectomy with a diversion of the remaining distal pancreas was carried out. The authors reviewed national and international publications.

First case reported of Bouveret´s syndrome associated to duodenal and biliary perforation to retroperitoneum.

We present the case of a 69 year old woman with a history of cholecystitis, who consulted for severe abdominal pain, nausea and vomiting. Abdominal CT showed duodenal obstruction caused by a gallstone, cholecystoduodenal fistula and pneumobilia, what is known as Bouveret's syndrome, a rare form of gallstone ileus. Additionally, she presented free duodenal and vesicular perforation to retroperitoneum at the same level of the cholecystoduodenal transit point. The patient underwent a difficult cholecystectomy, enterolithotomy, repair of the duodenal defect, extensive washing and drainage of the retroperitoneum. The postoperative course was uneventful except for a laparotomy infection.

Primer caso publicado de síndrome de Bouveret asociado a perforación duodenal y vesicular al retroperitoneo / First case reported of Bouveret´s syndrome associated to duodenal and biliary perforation to retroperitoneum

Presentamos el caso de una mujer de 69 años con diagnóstico de colelitiasis, que acudió a urgencias por cuadro de dolor abdominal intenso, náuseas y vómitos. Un TAC abdominal mostró obstrucción duodenal causada por cálculo biliar de 4 cm, fístula colecistoduodenal y neumobilia, lo que en conjunto se conoce como síndrome de Bouveret, una forma rara de íleo biliar. Adicionalmente presentaba perforación duodenal y vesicular libre a retroperitoneo en el mismo punto de tránsito colecistoduodenal. La paciente fue intervenida quirúrgicamente, realizando colecistectomía dificultosa, enterolitotomía, reparación del defecto duodenal, lavado exhaustivo y drenaje del retroperitoneo. El postoperatorio transcurrió sin complicaciones salvo infección de la herida quirúrgica (AU)

We present the case of a 69 year old woman with a history of cholecystitis, who consulted for severe abdominal pain, nausea and vomiting. Abdominal CT showed duodenal obstruction caused by a gallstone, cholecystoduodenal fistula and pneumobilia, what is known as Bouveret's syndrome, a rare form of gallstone ileus. Additionally, she presented free duodenal and vesicular perforation to retroperitoneum at the same level of the cholecystoduodenal transit point. The patient underwent a difficult cholecystectomy, enterolithotomy, repair of the duodenal defect, extensive washing and drainage of the retroperitoneum. The postoperative course was uneventful except for a laparotomy infection (AU)