Acute pancreatitis due to osteosarcoma metastasis.

We present the case of a young patient with acute pancreatitis (AP) secondary to osteosarcoma metastasis. It is necessary to assess tumor etiology in the study of any acute pancreatitis without clear cause. Pancreatic metastases are rare and difficult to diagnose and differentiate from other primary tumors such as neuroendocrine tumors (NET). It is essential to have a high degree of clinical suspicion and the use of radiological and endoscopic ultrasound imaging techniques.

Primary adenocarcinoma of the fourth portion of the duodenum, an unsuspected diagnosis.

Small bowel adenocarcinoma is a rare tumor accounting for only 0.3-0.4% of all gastrointestinal tumors, with duodenal adenocarcinoma being the most common subtype. In most patients, it presents with nonspecific signs and symptoms, often leading to a delay in diagnosis. Therefore, it is essential to establish an adequate initial clinical suspicion to carry out an adequate diagnostic approach, being necessary to perform both radiological and endoscopic diagnostic techniques.

Dubin-Johnson syndrome as a laparoscopic finding.

We present the case of a 35-year-old female with a history of polycystic ovary syndrome, treated with oral contraceptives. She was under study due to nine months evolution of pain in the right iliac fossa, associated with hyporexia and mild hyperbilirubinemia with a predominance of the conjugated fraction (total Bi 3.7 mg/dl, conjugated Bi 2.9 mg/dl). An abdominal computed tomography (CT) was performed showing homogeneous hepatosplenomegaly and adenopathies in both iliac chains, the largest in the right external iliac chain of 1.6 x 3.6 cm.

Perforación gástrica por palillo / Gastric perforation caused by a stick

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Nefritis intersticial aguda inducida por inhibidores de la bomba de protones: indicación poco frecuente de cirugía antirreflujo / Acute interstitial nephritis induced by proton-pump inhibitor: Uncommon indication of antireflux surgery

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Síndrome del muñón cístico como causa de síndrome poscolecistectomía / Cystic duct remnant syndrome as a cause of post-cholecystectomy syndrome

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Colangitis aguda asociada a hemobilia en un paciente con cirrosis hepática y cavernomatosis portal / Acute cholangitis and hemobilia in a patient with liver cirrhosis and portal vein cavernomatous transformation

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Rescate con rituximab en paciente con liquen plano esofágico refractario / Rituximab as rescue therapy in refractory esophageal lichen planus

El liquen plano esofágico (LPE) es una entidad poco frecuente cuya prevalencia se desconoce, que puede en ocasiones estar subestimada por los hallazgos sutiles e inespecíficos en las exploraciones realizadas. Las lesiones orales rara vez se extienden para afectar a la mucosa esofágica pero, cuando lo hacen, provocan disfagia y odinofagia. Esta infrecuente afectación del liquen plano conlleva un retraso en el diagnóstico y un tratamiento inadecuado. Se presenta el segundo caso (en nuestro conocimiento) de una paciente de 59 años con LPE, con buena respuesta al tratamiento con rituximab, un anticuerpo monoclonal quimérico dirigido específicamente contra la proteína CD20 presente en los linfocitos B (AU)

Esophageal lichen planus (ELP) is a rare condition with unknown prevalence that can sometimes be underestimated due to the subtle and nonspecific findings of diagnostic workup. Oral lesions rarely extend to the esophageal mucosa, but when they do, the most frequent symptoms are dysphagia and odynophagia. There is often a significant delay in diagnosis and inadequate treatment. We report the case of a 59-year-old woman diagnosed with ELP, successfully treated with rituximab, a chimeric monoclonal antibody that depletes CD20+B cells. To our knowledge, this is only the second report of this treatment in ELP (AU)

[Rituximab as rescue therapy in refractory esophageal lichen planus]. / Rescate con rituximab en paciente con liquen plano esofágico refractario.

Esophageal lichen planus (ELP) is a rare condition with unknown prevalence that can sometimes be underestimated due to the subtle and nonspecific findings of diagnostic workup. Oral lesions rarely extend to the esophageal mucosa, but when they do, the most frequent symptoms are dysphagia and odynophagia. There is often a significant delay in diagnosis and inadequate treatment. We report the case of a 59-year-old woman diagnosed with ELP, successfully treated with rituximab, a chimeric monoclonal antibody that depletes CD20+B cells. To our knowledge, this is only the second report of this treatment in ELP.

Endoscopic mucosal resection for proximal superficial lesions: efficacy and safety study in 59 consecutive resections.

INTRODUCTION: endoscopic mucosal resection is an accepted technique for the treatment of proximal gastrointestinal tract superficial lesions. OBJECTIVES: to evaluate the efficacy and safety of this procedure in the proximal gastrointestinal tract. MATERIAL AND METHODS: forty one consecutive patients (23 males and 18 females, mean age of 61 ± 11.5 years) were included in our study. Fifty nine resections were performed in these patients in 69 sessions. Lesions treated consisted of elevated lesions with high grade dysplasia in the context of Barrett's esophagus (group A), high grade dysplasia appearing in random biopsies taken during the follow-up of Barrett's esophagus (group B) and superficial gastroduodenal lesions (group C). Snare resection after submucosal injection, band ligator-assisted or cap-assisted mucosal resection were the chosen techniques. RESULTS: we resected 7 elevated lesions with high grade dysplasia in the context of Barrett's esophagus, 6 complete Barrett's esophagus with high grade dysplasia in 16 sequential sessions and 46 gastroduodenal superficial lesions (10 adenomas, 9 gastric superficial carcinomas, 18 carcinoid tumours and 9 lesions of different histological nature). Resections in the two first groups were complete in 100% of the cases, and in 97.9% of the cases in group C. Complications included 2 cases of limited deferred bleeding (groups A and B) and another two cases of stenosis with little clinical relevance in Group B. CONCLUSIONS: a) endoscopic mucosal resection is an efficient technique for the treatment of proximal gastrointestinal tract superficial lesions; b) it is a safe procedure with a low percentage of complications, which can generally be managed endoscopically; and c) in contrast with other ablative techniques, endoscopic mucosal resection offers the possibility of a pathologic analysis of the samples.

Resección endoscópica mucosa de lesiones superficiales altas: estudio de su eficacia y seguridad en 59 resecciones consecutivas / Endoscopic mucosal resection for proximal superficial lesions: efficacy and safety study in 59 consecutive resections

Introducción: la resección endoscópica mucosa es una técnica aceptada en el tratamiento de lesiones superficiales del tracto digestivo. Objetivos: evaluar la eficacia y seguridad de dicho procedimiento en el tracto digestivo superior. Material y métodos: se incluyeron en nuestro estudio 41 pacientes consecutivos (23 hombres y 18 mujeres, edad media de 60,6 años) a los que se les realizaron 59 resecciones en 69 sesiones. Se trataron las siguientes patologías: lesiones sobreelevadas con displasia de alto grado sobre esófago de Barrett (grupo A), displasia de alto grado en biopsias aleatorias del seguimiento de esófago de Barrett (grupo B) y lesiones superficiales gastroduodenales (grupo C). Las técnicas utilizadas fueron la resección con asa tras inyección submucosa, la asistida por bandas o por capuchón. Resultados: se resecaron 7 lesiones sobreelevadas con displasia de alto grado sobre esófago de Barrett, 6 esófagos de Barrett con displasia de alto grado de forma completa en 16 sesiones secuenciales de resección mucosa y 46 lesiones superficiales gastroduodenales (10 adenomas, 9 carcinomas gástricos superficiales, 18 carcinoides y 9 lesiones de diferente estirpe). Las resecciones se realizaron con éxito en el 100% de los dos primeros grupos y en el 97,9% del grupo C. Como complicaciones tuvimos 2 sangrados diferidos autolimitados (grupos A y B) y dos casos de estenosis con escasa relevancia clínica en el grupo B. Conclusiones: a) la resección endoscópica mucosa es una técnica eficaz en el tratamiento de lesiones superficiales del tracto digestivo superior; b) se trata de un procedimiento seguro, con un porcentaje de complicaciones muy bajo y que generalmente pueden ser manejadas de forma endoscópica; y c) al contrario que otras técnicas ablativas, permite el estudio anatomopatológico de las muestras(AU)

Introduction: endoscopic mucosal resection is an accepted technique for the treatment of proximal gastrointestinal tract superficial lesions. Objectives: to evaluate the efficacy and safety of this procedure in the proximal gastrointestinal tract. Material and methods: forty one consecutive patients (23 males and 18 females, mean age of 61 ± 11.5 years) were included in our study. Fifty nine resections were performed in these patients in 69 sessions. Lesions treated consisted of elevated lesions with high grade dysplasia in the context of Barrett’s esophagus (group A), high grade dysplasia appearing in random biopsies taken during the follow-up of Barrett’s esophagus (group B) and superficial gastroduodenal lesions (group C). Snare resection after submucosal injection, band ligator-assisted or cap-assisted mucosal resection were the chosen techniques. Results: we resected 7 elevated lesions with high grade dysplasia in the context of Barrett’s esophagus, 6 complete Barrett’s esophagus with high grade dysplasia in 16 sequential sessions and 46 gastroduodenal superficial lesions (10 adenomas, 9 gastric superficial carcinomas, 18 carcinoid tumours and 9 lesions of different histological nature). Resections in the two first groups were complete in 100% of the cases, and in 97.9% of the cases in group C. Complications included 2 cases of limited deferred bleeding (groups A and B) and another two cases of stenosis with little clinical relevance in Group B. Conclusions: a) endoscopic mucosal resection is an efficient technique for the treatment of proximal gastrointestinal tract superficial lesions; b) it is a safe procedure with a low percentage of complications, which can generally be managed endoscopically; and c) in contrast with other ablative techniques, endoscopic mucosal resection offers the possibility of a pathologic analysis of the samples(AU)

[Jaundice secondary to giant pancreatic serous cystoadenoma]. / Ictericia secundaria a cistoadenoma seroso pancreático gigante.

Serous cystadenoma is the second most frequent pancreatic cystic neoplasm and accounts for 1-2% of exocrine neoplasms of the pancreas. Recently, they have been identified more frequently, due to the improvement in imaging techniques. Differential diagnosis should be performed with mucinous cystoadenoma, due to the latter´s potential for malignant transformation. We present the case of a female patient who underwent examination for painless jaundice and cholestasis, with a final diagnosis of pancreatic serous cystoadenoma.