Revista Espanola De Enfermedades Digestivas最新文献

Ulcerative colitis (UC) is a chronic and relapsing inflammatory bowel disease (IBD) characterized by abdominal pain and bloody diarrhea. Its diagnosis requires endoscopy and biopsies for histopathological analysis, revealing characteristic endoscopic findings. Currently, the correlation between these endoscopic abnormalities and the histopathological diagnosis of UC remains a controversial topic in pediatrics. This study evaluated the clinicopathological association of various endoscopic alterations in UC. An analytical study of patients under 15 years old who underwent upper and lower gastrointestinal endoscopy for suspected IBD at a pediatric hospital between 2015 and 2022 was performed.

Terminal ileitis is a common finding in clinical practice and is often associated with Crohn's disease. However, other pathologies must be considered particularly those resulting from side effects of drugs. We report a case of an 18-year-old female that underwent renal transplant under mycophenolate sodium, tacrolimus, and prednisolone admitted for abdominal pain, diarrhea and weight loss. Abdominal ultrasound revealed terminal ileum wall thickness, extending through 6,6 cm, while a subsequent Ileocolonoscopy revealed normal ileal mucosae but congestive cecum mucosae with superficial ulcers. Histology revealed unspecific chronic inflammation. Under the hypothesis of drug-induced enterocolitis, and after multidisciplinary discussion, mycophenolate sodium was suspended, with a rapid recovery without further treatment. This case highlights the challenge of diagnosing ileocolitis and demonstrates that MS-induced lesions can present clinical and endoscopic changes similar to those seen in Crohn's disease. Although enteric-coated MS has delayed absorption from the GI tract compared to MMF, which might reduce GI adverse events, this difference does not seem to be statistically significant.

A 24-year-old man presented to our hospital because he found that his stool with intermittent blood for one month. The patient was healthy in the past. The patient had no family history of colorectal polyps or cancer. Gastroscopy showed normal. Colonoscopy revealed a solitary polyp with a long peduncle in the sigmoid colon, about 3.0cm in diameter, congestive edematous and erosion on the surface and chicken skin‑like in the surrounding mucosa. A clip was applied to the stalk and then the polyp was excised by electrocoagulation with a snare. Histopathological analysis revealed that the polyp was a juvenile polyp without any malignant signs.

Before starting a drug that suppresses immunity, it is of paramount importance to screen for hidden infections in patients with inflammatory diseases. Latent tuberculosis infection (LTBI) is a condition characterized by an immune response to M. tuberculosis antigens without clinical manifestations. The highest risk of progression to active disease occurs in individuals who are immunosuppressed or in children. Patients who are candidates for treatment with TNF-alpha inhibitors should be evaluated with interferon gamma release assays and a chest radiograph. We present a case of a 42 year old woman with a history of Crohn disease treated with infliximab and fever with adenopatys.

We present a case of a woman in her 70s, with right upper quadrant pain and jaundice, who underwent laparoscopic cholecystectomy 14 days, previously. The ultrasound and computer tomography scan revealed a fluid lesion in the gallbladder fossa with intrahepatic extension. At this point a wide differential diagnosis was possible. In order to reach a definitive diagnosis, a magnetic resonance imaging exam with a biliary excretion contrast agent - gadoxetate disodium (hepatobiliary specific paramagnetic gadolinium-based contrast) was obtained, which showed a lesion with delayed, but important contrast enhancement, 4 hours after contrast injection, demonstrating leaking of bile reaching the final diagnosis of biloma. Our patient was successfully treated with ultrasound-guided percutaneous drainage.

A 57-year-old woman presented to our department, complaining of abdominal pain for 1 week. Esophagogastroduodenoscopy (EGD) revealed a 0.3 × 0.4 cm, slightly elevated lesion located on the greater curvature of the upper gastric body, classified as type 0-IIa (superficial elevated). Narrow-band imaging (NBI) demonstrated brownish discoloration of the lesion's surface with a branching vascular pattern of dilated capillaries. Histopathological examination of the EGD biopsy revealed a gastric adenocarcinoma of fundic gland type. The observed cancerous lesion was treated via endoscopic submucosal dissection (ESD). Post-ESD histopathology confirmed a gastric adenocarcinoma of fundic gland type (histologic grade E). The tumor measured 2.8 mm in maximum diameter and focally invaded the submucosa, with the deepest invasive front extending 0.4 mm below the muscularis mucosae. Both lateral and vertical resection margins were free of carcinoma.

We present the case of a 75-year-old woman who presented to our hospital with upper gastrointestinal bleeding and altered liver function tests. MR cholangiography performed during hospitalization revealed a choledochoduodenal fistula. Gastroscopy confirmed the presence of this fistula, and after surgical correction, an adenocarcinoma at the biliopancreatic junction infiltrating the duodenum was diagnosed. This represents a rare and unusual presentation of biliopancreatic tumors, with endoscopy playing a crucial role in diagnosis.

A 17-year-old man with ulcerative colitis (UC) presented to our hospital with neck pain and fever after vomiting. On examination, a snowflake sensation was noted in the neck. A chest radiograph showed extensive subcutaneous emphysema in the chest. CT scans showed extensive subcutaneous emphysema in the neck, shoulders and axilla, as well as pneumomediastinum and pneumothorax. A diagnosis of pneumomediastinum with exacerbation of UC was made, and he was fasted and treated with antibiotics. Intensive granulocyte and monocyte adsorption apheresis (GMA) was started for exacerbation of UC. His symptoms and the radiological findings of pneumomediastinum improved. He remained in remission on azathioprine. UC is a chronic inflammatory bowel disease (IBD) associated with extraintestinal manifestations (EIM). Very few cases have been complicated by pneumomediastinum. The increase in alveolar pressure due to vomiting and systemic inflammation-related pleural or esophageal damage may cause pneumomediastinum in this case. Prevention of progression to mediastinitis and treatment of exacerbated UC are contradictory. GMA was successful because it was not an immunosuppressive therapy. Our case highlights that rare EIM may complicate exacerbation of UC.

A man in his 70s, without prior foreign body history, presented to the emergency department 15 days after accidentally inserting a tubular object into his anus. He reported a reduction in normal bowel movements. Initial physical examination was normal. An abdominal X-ray revealed a tubular hypodensity in the pelvic region, without perforation. Subsequently, it was decided to perform a colonoscopy during which a foreign body was visualized in the distal rectum, that was successfully removed with the use of a rat tooth forceps. The foreign body was a plastic tube about 18cm in size. Afterwards, the rest of the colon was assessed, having identified an ulcer in the lower rectum related to the presence of the object. Six months later, the patient reported no complains and a follow-up colonoscopy was conducted which was normal. Discussion: Rectal foreign bodies, whose size and shape are variable and sometimes aberrant, are often self-inserted for self-gratification by adults, and its incidence is increasing. Patients typically avoid immediate medical attention and seek help only when complications arise. Formal clinical guidelines are lacking, and this case illustrates the importance of clinical judgement in the management of rectal foreign bodies, whether endoscopic or surgical.

Acute pancreatitis is an uncommon adverse effect of sodium-glucose linked transporter 2 inhibitors (SGLT2is). Their use has notably increased in recent years, hence clinical suspicion is key in patients recently started on these drugs. We report the case of an 83-year-old male patient who was admitted for a first acute pancreatitis episode of unclear etiology that eventually was attributed to dapaglifozin, a SGLT2i in widespread use.