Revista Espanola De Enfermedades Digestivas最新文献

A 71-year-old male patient with a history of bladder neoplasia underwent Bricker-type surgery, during which an iatrogenic rectal injury occurred. During surgery, an unsuccessful suture attempt was made, leading to the appearance of fecaluria after 48 hours. A computed tomography scan revealed a small continuity defect in the rectal wall, accompanied by a 25-mm adjacent collection. Percutaneous drainage was placed in an attempt to achieve spontaneous closure, but this was unsuccessful. A rectoscopy was performed, identifying a wall defect in the mid-rectum. A review with a paediatric gastroscope confirmed communication to a cavity drained by urethra (recto-urethral fistula). Endoscopic vacuum therapy (EVT) (Endo-SPONGE®, B.Braun; Melsungen, Hesse, Germany) was initiated, achieving negative pressures (KCI Acelity V.A.C.® ATS® Negative Pressure Wound Therapy Unit; -100 mmHg). An endoscopic review after 72 hours confirmed the appearance of granulation tissue and the initiation of cavity closure. After three replacements (a total of four sponges), cavity collapse was achieved, but complete closure of the orifice was not attained. An over-the-scope clip (OTSC® 11.5-14 mm type-t, Ovesco; Tübingen, Baden-Wurttemberg, Germany) was placed, but fecaluria persisted, albeit with lesser intensity. Ultimately, successful closure was achieved by placing a second over-the-scope clip, two conventional hemoclips (Novaclip-R3 16 mm, Vytil; Hangzhou, Zhejiang, China), and instilling endoscopic biodegradable cyanoacrylate adhesive (Glubran® 2, GEM; Viareggio, Lucca, Italy).

A 67-year-old male was admitted to our hospital with a diagnose of a <1-cm clear dehiscence orifice at the gastroesophageal anastomosis. Considering of the cachexia state and the size of fistula, a new endoscopic clipping therapy, called mucosal incision-assisted closure with clips, was performed. The procedure as follows: First, used electrotome to puncture and destroy the epithelium of the fistula mouth. Then, mucosal incision was performed at the the proximal end of the fistula. Finally, one leg of the clip inserted into the dissected mucosa, and another leg was clamped to the fistula's opposite side to directly close the anastomotic defect. The whole process was finished in just a few minutes. After the operation, adequate nutrition and antibiotic support were given. The patient recovered rapidly and was discharged after 14 days without any complication. This successful case confirmed that mucosal incision-assisted closure with clips is a potentially viable and tight option for sealing esophageal leak, with excellent clamping and closing force.

This case involves a 69-year-old female with a history of Roux-en-Y gastric bypass who presented with gastric outlet obstruction of the excluded stomach, secondary to pancreatic cancer with malignant duodenal stenosis and confirmed liver metastasis. The excluded stomach was significantly dilated, posing a high risk of perforation.

Amoebiasis is an infection caused by the intestinal protozoan Entamoeba histolytica. It is transmitted via the faecal-oral route and primarily affects the intestinal tract and the liver. It is prevalent in tropical countries but is uncommon in Europe, where it is typically diagnosed in immigrants and tourists from endemic regions. However, an increase in autochthonous cases is being observed in Spain. A case is presented of a 56-year-old Spanish male with no relevant epidemiological history who attended the Emergency Department due to right hypochondrial pain and fever. An abdominal CT scan revealed circumferential mural thickening in the caecum and a large cystic mass in the right hepatic lobe. The study was completed with a colonoscopy, which showed ulcers with an infectious appearance in the caecum and right colon (biopsies were non-diagnostic), and an abdominal ultrasound, which characterised the hepatic lesion as an abscess. An ultrasound-guided drainage was performed and a sample was sent to Microbiology, which tested positive for Entamoeba histolytica. He received empirical antibiotic therapy with ceftriaxone and metronidazole, resulting in a favourable clinical outcome.

Introduction: Diagnosing perihilar cholangiocarcinoma can be challenging. Previous studies suggest that the sensitivity of taking three cholangioscopy-guided biopsies is approximately 70%. We hypothesized that obtaining four or more biopsies might improve the sensitivity for diagnosing perihilar cholangiocarcinoma.

Objective: To determine the acceptable number of cholangioscopy-guided biopsies to improve sensitivity for diagnosing perihilar cholangiocarcinoma.

Methods: This retrospective study analyzed clinical records of adults with perihilar stenosis who underwent cholangioscopy-guided biopsies. Patients with gallbladder cancer or metastatic bile duct obstruction were excluded. Data were grouped based on the number of biopsies taken: Group A (1 to 3 biopsies), Group B (4 to 6 biopsies), and Group C (7 to 10 biopsies). Results from each group were compared against a composite standard, including clinical follow-up and/or biopsies performed by alternative methods.

Results: The group that underwent 4 to 6 biopsies had a sensitivity of 77.4%, while the group with 7 to 10 had a sensitivity of 70.8%. The group with 1 to 3 biopsies had a sensitivity of 34.5%. Statistically significant differences were observed between the groups, with comparisons showing improved sensitivity in the 4 to 6 biopsy group versus the 1 to 3 biopsy group (χ² = 14.42, P = 0.0001), and the 7 to 10 biopsy group versus the 1 to 3 biopsy group (χ² = 6.56, P = 0.010).

Conclusions: Performing 4 to 6 cholangioscopy-guided biopsies significantly improves sensitivity for diagnosing perihilar cholangiocarcinoma compared to 1 to 3 biopsies. Further studies are needed to validate these findings.

Pneumatosis intestinalis is a rare disorder that can be secondary to a variety of causes among which includes oncological treatment. Most cases due to oncological treatment are reported with targeted therapy but there is growing number of cases secondary to tyrosin kinase inhibitors that includes Lenvatinib which it can be used in the treatment of hepatocarcinoma.

The incidence of hilar cholangiocarcinoma is (1-2) / 100,0001. Due to the high location of obstruction, the treatment of hilar cholangiocarcinoma is complicated, especially for patients with gastrointestinal surgery. The traditional ERCP technique is to find a way to place more stents to treat obstructive jaundice. When ERCP fails, (Percuteneous transhepatic cholangial drainage, PTCD) is often chosen, but the effect is not ideal. The reason is that patients do not want to carry a drainage tube, which affects the quality of life of patients. Secondly, PTCD technology is bile external drainage technology, which will affect the balance of water and electrolytes in the patient's body, and the patient's appetite will also decrease. Here, we provide a bridge technique of EUS-BD to solve the problem of simultaneous drainage of left liver and right liver with a stent, in order to provide a new treatment idea for endoscopists.

A 64-year-old man was admitted to the hospital due to "recurrent abdominal pain for 8 months" and had a history of multiple episodes of pancreatitis. CT scan showed an enlarged pancreas with no normal pancreatic tissue . Contrast enhancement scan in the arterial phase displayed moderate enhancement in the solid portion, while the cystic necrosis area showed no enhancement. It was suspected to be pancreatic cancer, and laparoscopic exploration of the pancreas followed by partial pancreatectomy was performed. Finally, it was confirmed as pancreatic squamous cell carcinoma by immunohistochemistry (P63 (+), CK5/6 (+)). Seven days after the operation, F18-FDG PET/CT showed multiple soft tissue density masses in the upper abdominal wall along the laparoscopic trajectory with increased uptake.

A 64-year-old man was admitted for hematemesis. Esophagogastroduodenoscopy revealed a gastric ulcer with a visible vessel on the posterior wall of the gastric body. After admission, the patient developed multiple episodes of massive hematemesis. During emergent esophagogastroduodenoscopy, he developed hemodynamic instability due to spurting bleeding. On day 18 of hospitalization, hemostasis was achieved using hemostatic forceps; however, contrast-enhanced computed tomography performed on the same day revealed a small splenic artery pseudoaneurysm (SAP) that had not been previously detected. To prevent fatal re-bleeding, interventional radiology was performed, and coil embolization was applied proximal to the pseudoaneurysm. The patient recovered without further hematemesis. One month later, exposed coils were observed from the healing ulcer, and celiac trunk angiography confirmed splenic artery thrombosis. Despite multiple attempts at endoscopic intervention, the patient developed recurrent hematemesis, suggesting that the gastric ulcer had eroded into the splenic artery, forming the SAP and causing significant hemorrhage. Although SAPs secondary to gastric ulcers are extremely rare, early recognition is critical because they carry a high risk of rupture and mortality. Endoscopic procedure alone may be insufficient, and an endovascular approach is a standard treatment to prevent life-threatening re-bleeding.

We present the case of a 27-year-old man, with no previous diseases, who was referred to the Department of Otorhinolaryngology in May 2023 for a 2-cm right submandibular lymphadenopathy of two month's evolution. He did not report fever or night sweats, and no oral or genital ulcers were observed. He presented eosinophilia in the analysis performed and a maculopapular exanthema on the left leg and malleolus areas, which was initially treated with topical antibiotic and corticosteroids. A soft tissue ultrasound revealed two right laterocervical lymphadenopathies at levels I and II. Given the suspicion of a primary hematological tumor, a PET-CT scan was conducted to complete the study, which revealed hypermetabolic laterocervical bilateral lymphadenopaties. In June 2023, a programmed cervicotomy was conducted, with complete excision of the right main lymphadenopathy in the Ib region, which showed a histological result of reactive lymphadenitis with intense eosinophilia, vascular proliferation, and fibrosis. These findings suggest Kimura disease as the first possibility. Due to sporadic episodes of choking that were not associated with specific food, persistent elevated IgE levels and eosinophilia in peripheral blood tests, and skin alterations, the study was completed with a gastroscopy to rule out the presence of eosinophilic esophagitis, which showed erosive duodenitis, with villous shortening and increased lymphoplasmacytic cellularity of the lamina propria, findings consistent with celiac disease, which was afterwards confirmed with the presence of positive anti-endomysial and transglutaminase antibodies, and the presence of HLA-DQ8 positive in homozygosis in the genetic study. The patient started systemic treatment with corticosteroids and gluten-free diet, which he continues to take at present.