[Acute appendicitis without Crohn's disease in a patient with inflammatory bowel disease. Case report]. / Apendicitis aguda sin enfermedad de Crohn en un paciente con inflamación intestinal. Informe de un caso.

BACKGROUND: Crohn's disease was described for the first time in 1932. The association of acute appendicitis with this disease is very rare and when the cecum is involved, risk of fistula is very high. CASE REPORT: We present the case of a 48-year-old female who had been diagnosed with Crohn's disease several months earlier. The patient complained of intense abdominal pain in the right lower quadrant and was treated medically without improvement. Thus, laparascopic surgery was decided upon. DISCUSSION: The appendix was affected in 12-16% of all patients with Crohn's disease who had intestinal resection. CONCLUSIONS: If the cecum is not affected, appendectomy using laparascopic procedure with soft tissue drainage is adequate.

Apendicitis aguda sin enfermedad de Crohn en un paciente con inflamación intestinal: informe de un caso / Acute appendicitis without Crohn's disease in a patient with inflammatory bowel disease: case report

BACKGROUND: Crohn's disease was described for the first time in 1932. The association of acute appendicitis with this disease is very rare and when the cecum is involved, risk of fistula is very high. CASE REPORT: We present the case of a 48-year-old female who had been diagnosed with Crohn's disease several months earlier. The patient complained of intense abdominal pain in the right lower quadrant and was treated medically without improvement. Thus, laparascopic surgery was decided upon. DISCUSSION: The appendix was affected in 12-16% of all patients with Crohn's disease who had intestinal resection. CONCLUSIONS: If the cecum is not affected, appendectomy using laparascopic procedure with soft tissue drainage is adequate.

[Villous adenoma of the rectum with severe hydroelectric alterations. Report of two cases]. / Adenoma velloso de recto con alteración hidroelectrolítica severa. Informe de dos casos.

BACKGROUND: Approximately 10% of all colorectal adenomas are constituted by villous adenomas. Their relationship with hydroelectrolytic depletion is rare. We report two cases with villous adenoma that presented hydroelectrolytic depletion with clinical and surgical management, exclusively. CLINICAL CASES: Case 1. Patient was a 76-year-old female with hypertension and 3 months evolution of symptoms such as asthenia, adynamia, unexplained weight loss, and abundant mucus with diarrhea. Serum potassium value was 2.2 mEq/l . Upon rectal exam we found a sessile, exophitic soft tumor with irregular surface of approximately 10 cm in diameter. We also performed a transanal resection of tumor reporting villous adenoma. The patient was discharged from the hospital at the 4th postoperative day with potassium values within normal limits. Case report 2. Patient was a 76-year-old female with diabetes and hypertension of long evolution. She reported a 4-month clinical evolution with non-bloody diarrhea and abundant mucus. She reported nausea, vomiting and no unexplained weight loss. Serum potassium value was 2.1 mEq/l . During the rectal exam we identified a sessile, polypoid, 5-cm diameter tumor that did not involve deep planes. In addition, we carried out a transanal resection of the polyp. The patient was discharged from the hospital on the 5th postoperative day. Potassium value was 4.3 mEq/l. CONCLUSIONS: Size and location of the villous adenoma are related to the production of mucus secretory diarrhea. The inhibiting well-known indomethacin of the prostaglandins has been used to decrease the mucus secretion. In every patient with presence of mucus, persistent diarrhea and occasional rectal bleeding of 1 month, it is necessary to carry out lower endoscopy to rule out the presence of villous adenoma.

[Intestinal damage by non-steroidal anti-inflammatory drugs]. / Daõ intestinal por antiinflamatorios no esteroideos.

BACKGROUND: Nonsteroidal antiinflammatory Drugs (NSAIDS) are the most widely prescribed medication in the world, with a high complication rate including gastrointestinal damage. OBJECTIVE: To present two clinical cases of intestinal damage associated to the chronic ingestion of NSAIDs. METHOD: A clinical case with inflammatory bowel disease and jejunum enteropathy and another case associated with clinical symptoms of digestive hemorrhage and endoscopic demostration of ulcers in the right colon. CONCLUSION: Patients with previous ingestion of NSAIDs presenting diarrhea, gastrointestinal bleeding, malnutrition or anemia need to discard intestinal damage.

[Hereditary mixed polyposis syndrome. First report in Mexico]. / Síndrome de poliposis mixta hereditaria. Primer reporte en México.

OBJECTIVE: Report for first time in Mexico a case of hereditary mixed polyposis and review the literature. BACKGROUND: The hereditary mixed polyposis syndrome (HMPS) is an uncommon condition, distinguished by presence of a different histological pattern of polyps in digestive tract, clinically manifested by diarrhea, anemia and weight loss. CASE REPORT: Male patient, 38 years old, with familiar antecedent (dead sister) with polyps and gastric cancer. With history of a 1 year with bleeding and mucous diarrhea, and weight loss of a 28.6 pounds. Pale at physical examination, without abdominal signs. At blood test with hemoglobin of 9.7 g/dL, and colonoscopy with multiple polyps within colon and rectum, upper endoscopy with a big esophageal polyp and multiple polyps in gastric and duodenal lining smaller than 1 cm. Contrast study of intestine was normal. Histopathologic study of the polyps report mixed pattern of polyps: (hyperplasic-adenomatous, juvenile-adenomatous, adenoma-inflammatory-hyperplasic, hyperplasic-adenomatous with a high degree dysplasia); juvenile in esophagus, and hyperplasic in stomach and duodenum. Patient was undergone to totalproctocolectomy and reconstruction by "J" ileoanal pouch with good outcome, and endoscopic esophageal polypectomy, with actual surveillance.