Laura Crespo Pérez

Una causa infrecuente de obstrucción gástrica: síndrome de Bouveret

Resumen El sindrome de Bouveret (SB) es un tipo infrecuente de ileo biliar consistente en una obstruccion gastroduodenal secundaria al paso de calculos desde la vesicula biliar al duodeno, a traves de una fistula colecisto o coledocogastroduodenal. La primera descripcion de este sindrome la realizo en 1896 Leon Bouveret. Desde esta epoca se han descrito en la literature medica poco mas de 200 casos. Si bien la mortalidad del cuadro se establece en un 25%, el pronostico viene determinado por la comorbilidad, la edad avanzada y el retraso en el diagnostico. Para llegar al diagnostico suelen precisarse tanto tecnicas radiologicas (radiografia simple, ecografia, tomografia computarizada o resonancia magnetica) como endoscopicas. Se debe intentar siempre el tratamiento endoscopico, aunque es muy frecuente que este sea fallido y sea preciso recurrir al tratamiento quirurgico. Presentamos el caso de un paciente que consulto por la aparicion de vomitos pospandriales y epigastralgia. A continuacion discutimos el manejo diagnostico y terapeutico de esta infrecuente causa de obstruccion gastrica.Bouverets syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.

Síndrome de hipersensibilidad a anticomiciales: una entidad para recordar

Anticonvulsant hypersensitivity syndrome is an unpredictable, potentially fatal drug reaction to aromatic anticonvulsants such as carbamazepine, phenytoin and phenobarbital. The hallmark features include fever, eosinophilia, rash and involvement of one or more internal organs. Clearly established diagnostic criteria and treatment guidelines are lacking. A high index of suspicion is required to identify this syndrome, allowing early withdrawal of the drug and avoiding re-exposure. We report an illustrative case of anticonvulsant hypersensitivity syndrome and review the published literature.

Enteropatía por olmesartán

cteriano, infecciones (por ejemplo, giardiasis, enfermedad de hipple, tuberculosis), linfoma intestinal, esprue colágeno, fermedad de Crohn, esprue tropical y fármacos. Tras el análisis de los casos reportados hasta la fecha, la mayorı́a los pacientes habı́an sido diagnosticados previamente de fermedad celiaca sin respuesta a la dieta libre de gluten o fermedad celiaca refractaria. No se ha descrito relación entre tiempo de exposición a olmesartán y el desarrollo de la teropatı́a. El daño del epitelio intestinal podrı́a estar en relación n la respuesta celular inmunomediada secundaria a un sequilibrio entre factores antiinflamatorios y proinflamatorios. linked to blood pressure medicine olmesartan medoxomil. 2013 [consultado 1 Mar 2014]. Disponible en: http://www.fda.gov/Drugs/DrugSafety/ucm359477. htm 2. Théophile H, David XR, Miremont-Salamé G, Haramburu F. Five cases of spruelike enteropathy in patients treated by olmesartan. Dig Liver Dis. 2014;46:465–9, http://dx.doi.org/10.1016/j.dld.2013.12.014 3. Stanich PP, Yearsley M, Meyer MM. Olmesartan-associated sprue-like enteropathy. J Clin Gastroenterol. 2013;47:894–5. 4. Rubio-Tapia A, Herman ML, Ludvigsson JF, Kelly DG, Mangan TF, Wu TT, et al. Severe spruelike enteropathy associated with olmesartan. Mayo Clin Proc. 2012;87:732–8. 5. Nielsen JA, Steephen A, Lewin M. Angiotensin-II inhibitor (olmesartan)-induced collagenous sprue with resolution following discontinuation of drug. World J Gastroenterol. 2013;19:6928–30. 6.

Atrofia vellositaria sin enfermedad celíaca: ¿un nuevo síndrome o más confusión?

It is not unusual for clinicians, particularly for those working in gastroenterology, to find intestinal villus atrophy (IVA) in duodenum biopsies from patients treated with chronic diarrhoea. In most cases, this finding rules out the existence of coeliac disease (CD)1. CD is an autoimmune disease that mostly develops in genetically predisposed subjects carrying HLA-DQ2/DQ82. To obtain a definitive diagnosis of CD, it is necessary not just to have compatible clinical data, but also to assess other findings, among them: the presence of positive serology, mainly through the detection of IgA or IgG anti-transglutaminase antibodies, or, in cases with negative serology or border levels, the presence of antiendomysial IgA antibodies; a compatible histology, standardised by means of the MARSH Classification3; and a clinical response to a glutenfree diet2. The new immunohistochemistry and flow cytometry techniques that make it possible to characterise the predominant lymphocyte subpopulations located in the intestinal lamina propria have not been available for that long. Thanks to these techniques, we have been able to establish how the increase of TCR gammadelta lymphocytes and the decrease of NK CD3+/CD7lymphocytes are findings specifically associated with CD4, thus facilitating the differential diagnosis of other diseases. These techniques are not available for every medical centre. In spite of the aforesaid, CD diagnosis is not always easy to obtain, since there is a small group of patients who have IVA and are responsive to a gluten-free diet but whose antibodies are negative, resulting in the creation of the increasingly widespread seronegative CD concept. Even though CD is the most frequent cause of IVA1, there are other less frequent processes that may trigger it (table 1), widening a range of diagnostic possibilities before this histological finding

Utilidad de la cápsula endoscópica urgente en hemorragia digestiva grave secundaria a hemangiomatosis intestinal difusa

La hemangiomatosis intestinal difusa es una entidad rara caracterizada por la presencia de numerosas lesiones tumorales benignas, habitualmente de tipo vascular cavernoso, localizadas en estómago, intestino delgado y/o colon. Puede acompañarse de lesiones similares en piel y/o tejidos blandos de la cabeza y cuello. Los hemangiomas son los tumores más frecuentes en la edad infantil, por ello esta entidad ha sido descrita generalmente en pacientes pediátricos. Durante esta etapa los hemangiomas crecen paralelamente al desarrollo infantil y la forma más frecuente de inicio es la aparición de anemia o hemorragia digestiva. El diagnóstico de esta enfermedad suele realizarse mediante panendoscopia oral, colonoscopia o videocápsula endoscópica. Los estudios angiográficos suelen ser normales a pesar de que generalmente el número de lesiones es elevado. Se ha postulado que en la hemangiomatosis intestinal difusa existe una sobreproducción de factores de crecimiento angiogénico (VEGF), por ello se han utilizado sustancias antiangiogénicas como la talidomida o la somatostatina como opción terapéutica.