Endoscopic rescue of a fistulizing biliary plastic stent

55-year-old male with a history of cholecystectomy complicated by perforation of the common bile duct, contained with placement of a plastic biliary stent. He presented several subsequent episodes of recurrent cholangitis secondary to biliary lithiasis and residual benign stenosis of the common bile duct, resolved with the implantation of plastic biliary prostheses. Finally, given the recurrent episodes of cholangitis, it was agreed to perform a hepaticojejunostomy. During the operation, the last implanted stent was not detected, which was identified by CT scan of the abdomen, causing a fistulous tract between the duodenum and the ascending colon. The stent was removed endoscopically, without complications, and the fistulous tract was resolved.

Spontaneous cystogastric fistula: an accidental discovery

Pancreatic pseudocysts are very common cystic lesions after any inflammatory process of the pancreas. The majority are asymptomatic and only a small minority present complications or produce compression symptoms. However, this small minority must receive treatment, which depending on the clinical situation must be endoscopic, surgical or interventional radiology. We present the case of a patient with a ruptured pseudocyst for whom we avoided surgical treatment and opted for conservative treatment, with good evolution.

Drug-induced sudden dysphagia

Doxycycline is a bacteriostatic antibiotic of the tetracycline group widely indicated in the treatment of numerous infections (skin, soft tissues...). Given its acid nature, doxycycline is able to potentially generate mucous damage acting as a caustic; therefore, when the capsule of doxycycline (high concentrated substance) is taken inappropriately (with a small quantity of liquid or just before laying down) and remains for a longer time in contact with the esophagus, doxycycline may cause esophagitis-type lesions and ulcerations.

Acute necrotising pancreatitis secondary to a pancreatic foreign body

Most ingested foreign bodies are passed along the gastrointestinal tract without complications. Only 1% result in complications, with sharp objects, such as fish bones, being the most frequently involved. One of the potential complications is mucosal perforation, which can reach solid organs such as the liver or pancreas in up to 1% of cases. CT is considered the most effective imaging test for detection and to rule out the presence of complications. Early management is a determining factor in prognosis, with laparoscopic and laparotomy removal being considered, although in recent years endoscopic removal has been gaining in importance.

Anorectal malignant melanoma, a diagnostic challenge

Malignant anorectal melanoma is an extremely rare cause of rectal neoplasia, accounting for less than 1% of all melanomas and about 4% of all malignant colorectal neoplasms. We present the endoscopic and pathological images of a case in our clinical practice.

Disconnected pancreatic duct syndrome. Endoscopic approach

Disconnected pancreatic duct syndrome (DPCS) is due to disruption of the main pancreatic duct (PC) or its secondary branches, a complication present in 30-80% of acute necrotizing pancreatitis. The secretion of pancreatic enzymes by isolated functioning pancreatic tissue can facilitate the recurrence of encapsulated necrotic collections, so its endoscopic management remains a controversial issue in daily practice. We present a case of disconnected pancreatic duct syndrome resolved after placement of a pancreatic stent.

Large perforated gastric ulcer due to cocaine use

Juxtapyloric perforation is one of the most common digestive tract complications associated with cocaine use. We present the case of an habitual user of cocaine who goes to the Emergency Department due to epigastric pain due and intolerance of days of evolution. An endoscopic finding of a large antral ulcer with an ischemic appearance; in which it is not possible to show pylorus.

Aortomesenteric clamp: association with Wilkie syndrome and nutcracker syndrome

A 67-year-old female was referred due to epigastric pain, vomiting and weight loss of 6 kg in the past months. Blood tests were performed showing hematuria. An abdominal Doppler ultrasound did not show anything abnormal. Thus, an abdominal computed tomography (CT) angiography and a magnetic resonance imaging (MRI) enterography were performed, objectifying an aortomesenteric angle of 10.8° (reference range 38-56°), which caused a complete collapse of the left renal vein ("nutcracker phenomenon") and duodenal compression with retrograde dilatation ("Wilkie syndrome"). Conservative measures and nutritional support were adopted during hospitalization. She was discharged due to a good tolerance to an oral diet, the absence of symptoms and a good contrast pass in the esophagogastroduodenal transit.