Utilidad de la colonoscopia en la colitis isquémica / Usefulness of colonoscopy in ischemic colitis

Introducción: la colitis isquémica es la causa más frecuentede isquemia intestinal. Realizamos un estudio con el objetivo deanalizar las características demográficas, clínicas y la utilidad de lacolonoscopia en los pacientes diagnosticados de colitis isquémicaen nuestro centro en relación a un cambio de actitud terapéutica.Método: estudio retrospectivo en el que se seleccionaron 112pacientes diagnosticados de colitis isquémica mediante colonoscopiay biopsia, en un periodo de tiempo de cinco años. Se analizaron:edad, sexo, motivo de exploración, factores de riesgo cardiovascular,grado endoscópico de isquemia, cambio en la actitudterapéutica, tratamiento y evolución.Resultados: la edad media de nuestros pacientes fue de 73,6± 12,1 años con una incidencia similar en ambos sexos (50,9%mujeres y 49,1% hombres). Los factores de riesgo asociados fueronla hipertensión arterial (61,1%), el tabaco (37,2%) y antecedentede accidente cardiovascular previo (52,2%). El motivo másfrecuente de realización de colonoscopia fue rectorragia (53,6%)seguido de dolor abdominal (30,4%), realizándose de forma urgenteen el 65,3% de los casos. La colonoscopia permitió uncambio en la actitud terapéutica en el 50% de los casos, aumentandoen la urgente al 65,75%. La mortalidad global fue del27,67%. La colitis isquémica grave (25%) fue más frecuente envarones (64,3%), y cuando la indicación de colonoscopia fue urgente(85,71%) y cursó con mortalidad alta (53,57%). En estos serealizó tratamiento quirúrgico en el 57,14% de los casos con unaevolución favorable en el 50%, mientras que los pacientes con colitisisquémica leve o moderada tuvieron un pronóstico mejor, conevolución favorable en el 80,95% de los casos y con menor requerimientode tratamiento quirúrgico (4,76%, p < 0,05).Conclusión: la colitis isquémica es más frecuente en la edadavanzada. La sintomatología más común es la rectorragia y el dolorabdominal...(AU)

Background: the ischemic colitis is intestinal the most frequentcause of ischemia. With this work we determine the demographicand clinical characteristics, and the usefulness of thecolonoscopy in the patients with ischemic colitis diagnosed in ourcentre in relation to a change of therapeutic attitude.Method: retrospective study in which were selected 112 patientsdiagnosed with ischemic colitis by colonoscopy and biopsy,in a period of five years. It was analyzed: age, sex, reason for examination,factors of cardiovascular risk, endoscopic degree of ischemia,change in the therapeutic attitude, treatment and outcome.Results: the average age was of 73.64 ± 12.10 years with anequal incidence in women (50.9%) and the men (49.1%). The associatedfactors were the HTA (61.1%), tobacco (37.2%) and antecedentsof cardiovascular episode (52.2%). The most frequentreason for colonoscopy was rectorrhagia (53.6%) followed of theabdominal pain (30.4%), being urgent the 65.3%. Colonoscopyallowed a change in the therapeutic attitude in the 50 increasingin the urgent one to the 65.75%. Global mortality was of27.67%. The serious ischemic colitis (25%) was more frequent inmen (64.3%) in urgent indication (85.71%) and attends with highmortality (53.57%). Surgical treatment in the 57.14% was madewith a good evolution in the 50%, whereas the patients with mildor moderate ischemic colitis had a better prognosis (favourableevolution in 80.95%) with smaller requirement of the surgicaltreatment (4.76%), p < 0.05.Conclusion: the colitis ischemic are more frequent in the olderage. The most frequent symptoms are the rectorrhagia and theabdominal pain. The colonoscopy is a useful technique to evaluatethe gravity and it induces a change of attitude according to the resultof the same one. The evidence of a serious colitis supposedan increase of the necessity of surgery and worse prognosis(AU)

Usefulness of colonoscopy in ischemic colitis.

BACKGROUND: the ischemic colitis is intestinal the most frequent cause of ischemia. With this work we determine the demographic and clinical characteristics, and the usefulness of the colonoscopy in the patients with ischemic colitis diagnosed in our centre in relation to a change of therapeutic attitude. METHOD: retrospective study in which were selected 112 patients diagnosed with ischemic colitis by colonoscopy and biopsy, in a period of five years. It was analyzed: age, sex, reason for examination, factors of cardiovascular risk, endoscopic degree of ischemia, change in the therapeutic attitude, treatment and outcome. RESULTS: the average age was of 73.64 + or - 12.10 years with an equal incidence in women (50.9%) and the men (49.1%). The associated factors were the HTA (61.1%), tobacco (37.2%) and antecedents of cardiovascular episode (52.2%). The most frequent reason for colonoscopy was rectorrhagia (53.6%) followed of the abdominal pain (30.4%), being urgent the 65.3%. Colonoscopy allowed a change in the therapeutic attitude in the 50 increasing in the urgent one to the 65.75%. Global mortality was of 27.67%. The serious ischemic colitis (25%) was more frequent in men (64.3%) in urgent indication (85.71%) and attends with high mortality (53.57%). Surgical treatment in the 57.14% was made with a good evolution in the 50%, whereas the patients with mild or moderate ischemic colitis had a better prognosis (favourable evolution in 80.95%) with smaller requirement of the surgical treatment (4.76%), p < 0.05. CONCLUSION: the colitis ischemic are more frequent in the older age. The most frequent symptoms are the rectorrhagia and the abdominal pain. The colonoscopy is a useful technique to evaluate the gravity and it induces a change of attitude according to the result of the same one. The evidence of a serious colitis supposed an increase of the necessity of surgery and worse prognosis.

[Idiopathic esophageal ulcer with fistulization to the bronchial tree in a HIV-positive patient]. / Ulcera esofágica idiopática fistulizada a arbol bronquial en paciente VIH-positivo.

Idiopathic esophageal ulcerations (IEUs) associated with human immunodeficiency virus (HIV) infection are now recognized as an important cause of esophageal disease in this population. We report one case of IEU complicated with a fistula to the bronchial tree. Given his variable appearance, which may mimic other causes of esophageal ulceration and the high response rate to oral corticosteroid therapy, all HIV infected patients with esophageal ulceration should undergo endoscopy with biopsy to obtain a definitive diagnosis. We review the literature about the etiology, pathogenesis, management and treatment of the IEU.

[Post-radiation enteritis: double jejuno-colic stenosis]. / Enteritis post-radiación: doble estenosis yeyuno-cólica.

Radiation enteritis is a common complication in patients receiving radiotherapy as a part of the treatment of abdominal malignancies. We report the case of a 57 year male patient with a renal carcinoma, who received radiotherapy and developed a double stenosis of the jejunum and the colon ten years later. He had to be treated surgically with resection of the affected segments. We would like to stress the possibility of this complication in patients who are to be treated with radiotherapy.

[Role of endoscopy in caustic gastroesophageal lesions]. / Papel de la endoscopia en las lesiones cáusticas gastroesofágicas.

From 1984 to 1989 we have examined endoscopically 191 patients who ingested, for different causes, some type of caustic substance. The mean age was 36.8 +/- 21 years. 57% were female and 43% males. The most common substance was lye (52%). The clinical symptoms consisted mainly of epigastric pain and odynophagia. The most prevalent lesion was oesophagitis, of variable degrees (58%). Complications related to the ingestion of the caustic appeared in 20% of the patients; three of them died. The most common sequela was oesophageal stenosis and secondly gastric stenosis. Males ingested acids more frequently than females (P less than 0.001). In 20% of the cases the ingestion of the caustic was for suicide while in children all the cases were accidents.

[Angiodysplasia of the colon. Experience in 60 cases]. / Angiodisplasias de colon. Experiencia en 60 casos.

A review was made of 60 angiodysplasias of the colon (AD) found retrospectively among 2,750 colonoscopies. The most frequent clinical manifestation was rectal bleeding (65%); mean patient age was 63 years. More than a fourth of the angiodysplasias (26.6%) was located in the left colon, as compared to 66.6% in the cecum and ascending colon. Most of the lesions were multiple and less than 5 mm in diameter. Twenty-two percent of the patients were cirrhotics and 15% had an aortic valvular lesion. The most outstanding aspects of the process are reviewed.

[Colonoscopic approach in the therapy of sigmoid volvulus]. / Abordaje colonscópico en el tratamiento del vólvulo sigmoide.

We present 13 patients with 15 episodes of colonic volvulus, who underwent colonoscopy to decompress and/or devolvulate. Colonoscopic exploration demonstrated a non obstructive dilatation in three cases. In the remaining 10 patients, with 12 episodes of volvulus, decompression was obtained in 83.3% and devoluvulation in 41.6%. There were two failures, due to peritoneal metastases and adhesions which fixed the volvulus. In 40% of the cases there were mild ischemic signs. Forty per cent of the patients were submitted to elective surgery and the two failures (20%) were operated in emergency. The remaining 4 patients declined surgical treatment. At is allows differential diagnosis, we think that, for these patients, colonoscopy should be the first therapeutic approach; it also allows decompression and/or devolvulation and an early diagnosis of the associated ischemia.

Radiologic pitfalls in endoscopic retrograde pancreatography.

Endoscopic pancreatography (ERCP) is currently the least invasive technique for obtaining detailed images of the pancreatic ductal system. Although expert ERCP is now an acceptably safe procedure, interpretation of endoscopic pancreatograms may be difficult, and misdiagnosis is still a risk to the patient. We have been able to divide misinterpretations into three broad categories: technical error, anatomic variation, and unusual images due to disease. Examples of each of these classifications are presented and discussed in hopes of decreasing the incidence of misdiagnosis.