Scielo RSS <![CDATA[Revista Española de Enfermedades Digestivas]]> http://scielo.isciii.es/rss.php?pid=1130-010820160001&lang=pt vol. 108 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://scielo.isciii.es/img/en/fbpelogp.gif http://scielo.isciii.es <![CDATA[<b>A one-stop clinic in gastroenterology</b>: <b>benefits and limitations</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Efficacy of a high-resolution consultation system in gastroenterology at an Andalusian hospital center</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100002&lng=pt&nrm=iso&tlng=pt Background: By high resolution consultation (HRC) we mean an ambulatory process of assistance fulfilled in a single day, by which treatment and diagnosis are established and recorded. Objective: To assess to which extent patients with digestive conditions may benefit from a single consultation system. Material: A descriptive study of 179 first visit events, randomly selected as high-resolution consultations in gastroenterology. We discuss the percentage of patients who benefited from HRC and the complementary tests performed. Results: Most common conditions included dyspepsia (16%), a family history of colon cancer (16%) and gastroesophageal reflux disease (GERD) (16%). Seventy-nine (44%) of all first visits became HRCs and 80 (45%) required a diagnostic test (100% abdominal ultrasound) that was reviewed on the same day. Performing a test on the same day significantly increased the percentage of HRCs (57% vs. 34%, p < 0.002). GERD, dyspepsia, cholelithiasis and chronic liver disease were the subjects most commonly leading to HRC. Conclusions: Gastroenterology consultations may largely benefit from an HRC system with only organizational changes and no additional costs.<hr/>Antecedentes: la consulta alta resolución o única es aquel proceso asistencial ambulatorio en el que queda establecido un diagnóstico junto con su correspondiente tratamiento y reflejados ambos en un informe clínico, siendo realizadas estas actividades en una sola jornada. Objetivos: conocer en qué grado los pacientes con patología digestiva pueden beneficiarse del sistema de consultas en acto único. Material: estudio descriptivo de 179 episodios de primeras vistas seleccionadas aleatoriamente de una consulta de alta resolución de gastroenterología. Analizamos el porcentaje de pacientes que se beneficiaron de una consulta en acto único así como de las pruebas complementarias realizadas. Resultados: las patologías más frecuentes atendidas fueron la dispepsia (16%), los antecedentes familiares de cáncer de colon (16%) y enfermedad por reflujo gastroesofágico (16%). Setenta y nueve (44%) de las primeras visitas se resolvieron en consulta única y 80 (45%) de una prueba diagnóstica (100% ecografía abdominal) y revisión tras esta en el mismo día. La realización de una prueba en el día incrementaba significativamente el porcentaje de consulta única frente a los que no se les realizaba (57% frente a 34%, p < 0,002). Los pacientes con enfermedad por reflujo gastroesofágico, dispepsia, colelitiasis y hepatopatía crónica eran las patologías que terminaban en mayor porcentaje en consulta única. Conclusiones: las consultas de gastroenterología pueden beneficiarse en gran medida de un sistema de consulta de alta resolución solo con cambios organizativos y sin costes adicionales especiales. <![CDATA[<b>Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100003&lng=pt&nrm=iso&tlng=pt Introduction: Leiomyomas are the most common benign tumors of the esophagus. Although classically surgical enucleation through thoracotomy or laparotomy has been widely accepted as treatment of choice, development of endoscopic and minimally invasive procedures has completely changed the surgical management of these tumors. Material and methods: We performed a retrospective review of all esophageal leiomyoma operated at Hospital Universitario Ramón y Cajal (Madrid, Spain) between January 1986 and December 2014, analyzing patients' demographic data, symptomatology, tumor size and location, diagnostic tests, surgical data, complications and postoperative stay. Results: Thirteen patients were found within that period, 8 men and 5 women, with a mean age of 53.62 years (range 35-70 years). Surgical enucleation was achieved in all patients. In 8 cases (61.54%) a thoracic approach was performed (4 thoracotomies and 4 thoracoscopies), and in 5 cases (38.56%) an abdominal approach was performed (3 laparotomies and 2 laparoscopies); enucleation was carried out through a minimally invasive approach in 6 patients (46.15%). There were no cases of endoscopic resection alone. Surgery mean length was 174.38 minutes (range 70-270 minutes) and median postoperative stay was 6.5 days (range 2-27 days). There was neither mortality nor cases of intraoperative complications were described. No postoperative major complications were reported; however one patient presented important pain in his right hemithorax that required management and long term follow-up by the Pain Management Unit. With a mean follow-up of 165.57 months (median 170; range 29-336 months) no recurrences were reported. Conclusion: Enucleation is the treatment of choice for the majority of esophageal leiomyomas. In our experience, duration of the surgical procedure through minimally invasive approach was longer than surgery through open approach; however, postoperative stay was shorter in the first group. Paradoxically, incision pain after surgery (thoracic neuralgia) was found to be higher in the minimally invasive approach group. Nevertheless, none of the results obtained in the study reached statistical significance, probably due to the small simple size.<hr/>Introducción: el leiomioma es el tumor benigno más frecuente del esófago. Aunque clásicamente, el tratamiento de este tipo de tumores ha consistido en la enucleación por medio de una laparotomía o toracotomía, el auge de las técnicas endoscópicas y mínimamente invasivas ha revolucionado totalmente el manejo terapéutico de este tipo de tumores. Material y métodos: realizamos un estudio retrospectivo de todos los leiomiomas esofágicos intervenidos en el Hospital Universitario Ramón y Cajal entre el 1 de enero de 1986 y el 31 de diciembre de 2014, analizando características demográficas de los pacientes, sintomatología, localización tumoral, pruebas diagnósticas, datos quirúrgicos, complicaciones y estancia hospitalaria. Resultados: encontramos un total de 13 pacientes, siendo 8 varones y 5 mujeres, con una edad media de 53,62 años (rango 35-70 años). El tratamiento quirúrgico fue en todos los casos una enucleación. En 8 casos (61,54%) se realizó un abordaje torácico (4 toracotomías y 4 toracoscopias) y en 5 casos (38,56%) el abordaje fue abdominal (3 laparotomías y 2 laparoscopias). La enucleación se llevó a cabo a través de un abordaje mínimamente invasivo en 6 pacientes (46,15%). No hubo ningún caso de resección puramente endoscópica. La media de duración de la cirugía fue de 174,38 minutos (rango 70-270 minutos) y la mediana de estancia hospitalaria de 6,5 días (rango 2-27 días). No se describió ningún caso de mortalidad ni complicación intraoperatoria, aunque un paciente presentó importante dolor en hemitórax derecho que requirió manejo y seguimiento por la unidad del dolor. Con un seguimiento medio de 165,57 meses (mediana 170; rango 29-336 meses), no se han observado recidivas. Conclusiones: la enucleación constituye el tratamiento de elección en la mayor parte de los leiomiomas esofágicos. En nuestra experiencia, la duración de la cirugía es mayor tras cirugía mínimamente invasiva (CMI) que tras cirugía abierta (CA), sin embargo, la estancia media hospitalaria es menor. Paradójicamente, en valores absolutos, las complicaciones relacionadas con el dolor de la herida quirúrgica (neuralgia torácica) son mayores en el grupo de CMI. Sin embargo, ninguno de los resultados obtenidos en el trabajo es estadísticamente significativo, seguramente debidos al escaso tamaño muestral. <![CDATA[<b>Antibiotic prophylaxis in elective cholecystectomy</b>: <b>protocol adequacy and related outcomes in a retrospective single-centre analysis</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100004&lng=pt&nrm=iso&tlng=pt Background: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. Methods: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. Results: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found. <![CDATA[<b>Duodenal fistula after gastrectomy</b>: <b>retrospective study of 13 new cases</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100005&lng=pt&nrm=iso&tlng=pt Introduction: Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. Material and methods: We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay. Results: In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%). In 8 of the 13 patients (61.5%) surgery was the treatment of choice and in 5 cases (38.5%) conservative treatment was carried out. Postoperative mortality associated with DSF was 46.2% (6 cases). In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75%) died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days). Conclusion: FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment.<hr/>Introducción: la fístula del muñón duodenal (FMD) es una de las complicaciones más agresivas tras una gastrectomía. Aunque la incidencia reportada en la literatura es baja, su asociación con una elevada morbimortalidad hace que sea una de las complicaciones más temidas por los cirujanos. Material y métodos: evaluamos de forma retrospectiva todas las FMD acaecidas en nuestro centro tras realizar una gastrectomía programada por neoplasia gástrica, en el periodo comprendido entre enero de 1997 y diciembre de 2014. Analizamos variables demográficas, oncológicas y quirúrgicas, así como la evolución posterior en términos de morbimortalidad y estancia hospitalaria. Resultados: en el periodo que comprende el estudio se realizaron 666 gastrectomías y observamos una FMD en 13 pacientes, lo que supone una incidencia del 1,95%. En 8 casos (61,5%) se efectuó un tratamiento quirúrgico, y en 5 casos (38,5%), un tratamiento conservador. La mortalidad postoperatoria asociada a una FMD fue del 46,2% (6 casos). En el grupo quirúrgico, 3 pacientes presentaron una sepsis grave con fracaso multiorgánico, 2 una hematemesis importante que requirió la realización de hemostasia endoscópica, una evisceración, y un absceso subfrénico que requirió drenaje percutáneo. Seis de los pacientes (75%) fallecieron a pesar del tratamiento quirúrgico, siendo 3 de las muertes en las primeras 24 horas tras la reintervención. Los 2 pacientes que consiguieron sobrevivir tras la reintervención presentaron una estancia de 45 y 84 días respectivamente. En el grupo de tratamiento conservador, la tasa de curación fue del 100%, no observándose complicaciones significativas y siendo la estancia media postoperatoria de 39,5 días (rango, 26-65 días). Conclusión: la FMD constituye una complicación poco frecuente pero asociada a una elevada morbimortalidad. En nuestra experiencia, el manejo conservador ha demostrado mejores resultados en cuanto a morbimortalidad en comparación con el tratamiento quirúrgico. <![CDATA[<b>Epithelioid angiomyolipoma of the liver</b>: <b>clinicopathological correlation in a series of 4 cases</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100006&lng=pt&nrm=iso&tlng=pt Hepatic angiomyolipoma is a rare neoplasm that can be difficult to diagnose in cases of ecoguide biopsy. We studied 4 cases of female patients with a mean age of 51 years. None of the patients presented specific abdominal symptoms, or other tumour masses detected by chance. One of them had relevant personal history: Renal cell carcinoma. This same patient was diagnosed with a contralateral renal angiomyolipoma. None of the patients showed evidence of tuberous sclerosis. Three tumours have been diagnosed by biopsy and only in one patient was decided to completely remove the tumour surgically. None of the patients had evidence of recurrence of disease or an increase in tumour size over an average period of 45 months. Histologically, the tumours have been sub classified into angiomyolipomas epithelioid. In 50% of the cases, extramedullary haematopoiesis was observed. The first diagnostic impression using imaging methods included: Focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma and metastasis. By immunohistochemistry, it has been demonstrated that all tumours expressing melanocytic markers (HMB45 and Melan A) and markers of smooth muscle cells (smooth muscle actin). The diagnosis of these tumours is increasing due to programmes for early detection of hepatocellular carcinoma in patients with liver cirrhosis. It must be taken into account their broad spectrum of morphological diversity to avoid incorrect diagnosis of a malignant neoplasm.<hr/>El angiomiolipoma hepático es una neoplasia rara que puede llegar a ser difícil de diagnosticar en casos de biopsia ecoguiada. Hemos estudiado 4 casos de pacientes de sexo femenino, con una media de edad de 51 años. Ninguno de los pacientes se ha presentado con síntomas abdominales específicos, ni otras masas tumorales detectadas incidentalmente. Uno de ellos tenía antecedentes personales relevantes: carcinoma de células renales. Este mismo paciente fue diagnosticado de un angiomiolipoma renal contralateral. Ninguno de los pacientes ha mostrado evidencia de padecer esclerosis tuberosa. Tres de los tumores han sido diagnosticados por biopsia y en sólo uno de los pacientes se ha decidido la extirpación quirúrgica completa del tumor. En ninguno de los pacientes se ha observado evidencia de recidiva de la enfermedad o aumento del tamaño tumoral durante un periodo medio de 45 meses. Histológicamente los tumores se han subclasificado en angiomiolipomas epitelioides. En el 50% de los casos se ha observado hematopoyesis extramedular. La primera impresión diagnóstica mediante métodos de imagen incluía: hiperplasia nodular focal, adenoma hepático, carcinoma hepatocelular y metástasis. Mediante técnicas de inmunohistoquímica se ha demostrado que todos los tumores expresaban marcadores melanocíticos (HMB45 y Melan A) y marcadores de células musculares lisas (actina de músculo liso). El diagnóstico de estos tumores está aumentando debido a los programas de detección precoz de carcinoma hepatocelular en pacientes con cirrosis. Hay que tener en cuenta su amplio espectro de diversidad morfológica para evitar el diagnóstico incorrecto de una neoplasia maligna. <![CDATA[<b>Anal intraepitelial neoplasia</b>: <b>a narrative review</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100007&lng=pt&nrm=iso&tlng=pt Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population.<hr/>La neoplasia intraepitelial anal (AIN) constituye un importante problema de salud en ciertos grupos de riesgo como los pacientes con inmunodepresión de diverso origen, varones que mantienen relaciones sexuales con otros hombres, y mujeres con antecedentes de alteraciones en la citología cervical y/o vaginal. Está bien demostrada su relación con la infección del virus del papiloma humano (HPV), sin embargo se desconocen muchos de los factores implicados en la progresión y regresión de la infección viral a la displasia y al carcinoma anal. La pruebas diagnósticas de elección son la citología del canal anal y la anuscopia de alta resolución con biopsias dirigidas, aunque existe controversia sobre la necesidad de realización de la misma en poblaciones de riesgo. El tratamiento del AIN depende de los factores de riesgo y la necesidad de tratamiento local es controvertida debido a la alta tasa de recurrencia y morbilidad de las técnicas utilizadas. La biopsia quirúrgica está justificada sólo ante lesiones macroscópicas sugestivas de progresión. La vacunación frente al HPV para una prevención primaria en pacientes de alto riesgo ha sido debatida entre diferentes grupos, sin embargo no existe consenso sobre su implantación ni tampoco sobre la realización de un cribado en esta población. <![CDATA[<b>Splenosis</b>: <b>non-invasive diagnosis of a great mimicker</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100008&lng=pt&nrm=iso&tlng=pt Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population.<hr/>La neoplasia intraepitelial anal (AIN) constituye un importante problema de salud en ciertos grupos de riesgo como los pacientes con inmunodepresión de diverso origen, varones que mantienen relaciones sexuales con otros hombres, y mujeres con antecedentes de alteraciones en la citología cervical y/o vaginal. Está bien demostrada su relación con la infección del virus del papiloma humano (HPV), sin embargo se desconocen muchos de los factores implicados en la progresión y regresión de la infección viral a la displasia y al carcinoma anal. La pruebas diagnósticas de elección son la citología del canal anal y la anuscopia de alta resolución con biopsias dirigidas, aunque existe controversia sobre la necesidad de realización de la misma en poblaciones de riesgo. El tratamiento del AIN depende de los factores de riesgo y la necesidad de tratamiento local es controvertida debido a la alta tasa de recurrencia y morbilidad de las técnicas utilizadas. La biopsia quirúrgica está justificada sólo ante lesiones macroscópicas sugestivas de progresión. La vacunación frente al HPV para una prevención primaria en pacientes de alto riesgo ha sido debatida entre diferentes grupos, sin embargo no existe consenso sobre su implantación ni tampoco sobre la realización de un cribado en esta población. <![CDATA[<b>Liver abscess secondary to duodenal perforation by fishbone</b>: <b>report of a case</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100009&lng=pt&nrm=iso&tlng=pt Anal intraepitelial neoplasia (AIN) constitutes a major health problem in certain risk groups, such as patients with immunosuppression of varied origin, males who have sexual relations with other males, and females with a previous history of vaginal or cervical abnormalities in cytology. Its relationship with the human papillomavirus (HPV) infection has been well documented; however, many of the factors involved in the progression and regression of the viral infection to dysplasia and anal carcinoma are unknown. AIN can be diagnosed through cytology of the anal canal or biopsy guided by high-resolution anoscopy. However, the need for these techniques in high-risk groups remains controversial. Treatment depends on the risk factors and given the high morbidity and high recurrence rates the utility of the different local treatments is still a subject of debate. Surgical biopsy is justified only in the case of progression suggesting lesions. The role of the vaccination in high-risk patients as primary prevention has been debated by different groups. However, there is no general consensus on its use or on the need for screening this population.<hr/>La neoplasia intraepitelial anal (AIN) constituye un importante problema de salud en ciertos grupos de riesgo como los pacientes con inmunodepresión de diverso origen, varones que mantienen relaciones sexuales con otros hombres, y mujeres con antecedentes de alteraciones en la citología cervical y/o vaginal. Está bien demostrada su relación con la infección del virus del papiloma humano (HPV), sin embargo se desconocen muchos de los factores implicados en la progresión y regresión de la infección viral a la displasia y al carcinoma anal. La pruebas diagnósticas de elección son la citología del canal anal y la anuscopia de alta resolución con biopsias dirigidas, aunque existe controversia sobre la necesidad de realización de la misma en poblaciones de riesgo. El tratamiento del AIN depende de los factores de riesgo y la necesidad de tratamiento local es controvertida debido a la alta tasa de recurrencia y morbilidad de las técnicas utilizadas. La biopsia quirúrgica está justificada sólo ante lesiones macroscópicas sugestivas de progresión. La vacunación frente al HPV para una prevención primaria en pacientes de alto riesgo ha sido debatida entre diferentes grupos, sin embargo no existe consenso sobre su implantación ni tampoco sobre la realización de un cribado en esta población. <![CDATA[<b>Pelvic inflammatory myofibroblastic tumor mimicking a rectal cancer</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100010&lng=pt&nrm=iso&tlng=pt We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision. <![CDATA[<b>Hemoperitoneum secondary to an spontaneous rupture of the spleen mimmicking a duodenal perforated ulcera</b>: <b>a case report</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100011&lng=pt&nrm=iso&tlng=pt We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision. <![CDATA[<b>Graft <i>versus</i> host disease as a complication after liver transplantation</b>: <b>a rare but serious association</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100012&lng=pt&nrm=iso&tlng=pt We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision. <![CDATA[<b>Hemoperitoneum secondary to perforated inflammatory myofibroblastic tumor</b>: <b>a case report of an unusual complication</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100013&lng=pt&nrm=iso&tlng=pt We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision. <![CDATA[<b>Authors' reply</b>: <b>spanish or English in scientific reporting</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100014&lng=pt&nrm=iso&tlng=pt We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision. <![CDATA[<b>Gastric outlet obstruction</b>: <b>an unusual adverse event of percutaneous endoscopic gastrostomy</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100015&lng=pt&nrm=iso&tlng=pt We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision. <![CDATA[<b>Endoscopic submucosal dissection for a gastric fibrolipoma</b>]]> http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082016000100016&lng=pt&nrm=iso&tlng=pt We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper, we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision.