[SPONTANEOUS SPLEEN RUPTURE IN MONONUCLEOSIS INFECTIOUS DISEASE] / Ruptura espontánea del bazo por mononucleosis: Reporte de un caso.

This is the report of a patient with a 4-day history of a non-specific febrile syndrome, characterized by abdominal pain in the abscense of previous trauma. The abdominal ultrasound and Computerized Tomography showed marked hepatosplenomegaly and blood in the peritoneal cavity. An emergency splenectomy was performed, and the hospital course was complicated by and acute pancreatitis with a low-output fistula. The pathology specimen revealed the presence of a histologic picture compatible with Infectious Mononucleosis (IM), previously confirmed with serologic tests. The patient received antibiotics and had a favorable clinical course.

[PERCUTANEOUS ENCOSCOPIC GASTROSTOMY] / Gastrostomía Endoscópica Percutánea.

Percutaneous endoscopic gastrostomy is an increasingly utilized method of enteral nutrition in patients who for a variety of reasons, are unable to swallow or possess a high risk of aspiration. This method has replaced both surgical gastrostomy and the prolonged used of nasogastric tubes since its creation, in 1980. The most frequent indications are severe neurological diseases such as cerebrovascular accidents, Parkinson's, multiple sclerosis and other processes such as severe trauma, multi-infarct dementia or diverse head and neck tumors. The procedure involves the performance of an upper endoscopy in the usual manner, followed by an insertion of a plastic catheter percutaneously in the area of maximum contact between the gastric and abdominal walls, under direct endoscopic view. Then, a guidewire is introduced through the lumen of the catheter and is enlaced by a polypectomy snare passed through the working channel of the endoscope, utilizing the guidewire to tie the distal portion of the feeding tube, which will be pulled to its final position. The complications associated to this procedure are minimal, most of them related to the endoscopy itself, like reactions to sedation, aspiration of oropharyngeal secretions, etc. There is also a possibility of local infection at the insertion site, perforation of the colon and excessive leaking of gastric contents around the tube, and for these reasons the procedure should only be performed by trained physicians, familiarized with the management of these events. The goal of this review is to illustrate the reader about the indications, contral indications, complications and general considerations in the patients who will have a percutaneous endoscopic gastrostomy.