Pancreatic duct disruption may cause massive pancreatic ascites and mimic malignant or inflammatory peritoneal disease. A 57-year-old man developed progressive abdominal distension after blunt upper-abdominal trauma. Ascitic-fluid amylase was markedly elevated, whereas magnetic resonance cholangiopancreatography showed only mild pancreatic duct dilatation without a visible leak. After approximately 20 days of unsuccessful conservative treatment, endoscopic retrograde pancreatography was performed. Following failed major-papilla cannulation, access through the minor papilla demonstrated a partial pancreatic duct disruption at the pancreatic neck. The guidewire was advanced into the upstream pancreatic duct, and a 5-Fr × 7-cm single-pigtail plastic stent was placed across the leak. Ascitic-fluid amylase rapidly decreased and the ascites markedly improved. The stent was removed 3 months later, and no recurrent ascites occurred during the subsequent 6-month follow-up. Minor-papilla access may provide a rescue route for bridging pancreatic duct disruptions when conventional access fails.
Esophagogastric intramural hematoma is rare and may mimic varices or an upper gastrointestinal neoplasm. We report a hemodynamically stable patient receiving long-term aspirin therapy who developed melena after gastroscopy and colonoscopy at a referring hospital. Contrast-enhanced computed tomography showed a continuous hyperattenuating mural lesion extending approximately 16 cm from the distal esophagus across the esophagogastric junction into the cardia and gastric fundus, with a 3.8 × 2.6 cm mass-like fundal component and no active contrast extravasation, perforation or radiological evidence of portal hypertension. Endoscopy revealed bluish, varix-like submucosal bulging. Conservative treatment and temporary aspirin withdrawal resulted in substantial hematoma regression within six days, with subsequent ulcer formation in the distal esophagus and cardia. Biopsy of the cardial ulcer showed no evidence of malignancy. No recurrent bleeding or related symptoms occurred during one-month follow-up.
We read with great interest the article by Caballeros Lam et al. The authors show that low-dose thoracic computed tomography (CT) enables the detection of severe coronary artery calcifications in liver transplant recipients. As expected, severe coronary artery calcifications were associated with adverse cardiovascular events. The authors conclude that low-dose CT should be performed for lung cancer screening and for cardiovascular risk stratification in liver transplant recipients who smoke. Their findings are similar to the recently published from the Danish Comorbidity in Liver Transplant Recipients (DACOLT) study, although DACOLT used coronary CT angiography and these examinations are not interchangeable. DACOLT data show that living with a transplanted liver is associated with higher odds of any coronary atherosclerosis (odds ratio [OR]: 2.2), obstructive coronary atherosclerosis (OR: 2.7), and obstructive-extensive coronary atherosclerosis (OR: 3.9). Moreover, among individuals with any coronary atherosclerosis, liver transplant recipients had higher odds of having high-risk plaque than population control subjects (OR: 2.1). DACOLT investigators were unable to find an association of tobacco with coronary atherosclerosis, although this was probably related to limited power and confounding factors. Koshy et al. were also unable to find a significant association between tobacco consumption and progression of coronary atherosclerosis, although this could be expected due to the low number of liver transplant recipients they studied (n=30).
Sinusoidal obstruction syndrome (SOS) is an uncommon hepatic vascular complication classically associated with haematopoietic stem cell transplantation, although it may also occur following oxaliplatin-based chemotherapy. We report the case of a 52-year-old woman with stage III colon adenocarcinoma treated with adjuvant CAPOX who developed jaundice, ascites, rapid weight gain, thrombocytopenia, and severe liver dysfunction three weeks after completing chemotherapy. After other causes of acute liver injury had been excluded, Doppler ultrasound demonstrated reversal of portal venous flow and signs of portal hypertension consistent with SOS. Given the severity and rapid progression of the condition, treatment with defibrotide was initiated alongside supportive care, resulting in rapid clinical, biochemical, and radiological improvement. This case highlights that SOS may occur early, even after limited exposure to oxaliplatin in the adjuvant setting. Early recognition and assessment with hepatic Doppler ultrasound are essential to establish the diagnosis and initiate prompt treatment.
INTRODUCTION:abdominal bloating is common in irritable bowel syndrome (IBS), but its frequency and clinical associations remain incompletely characterized. We aimed to evaluate abdominal bloating frequency and its association with clinical burden in IBS classified using an operationalized Rome V algorithm. METHODS:in a prospectively recruited sample, we conducted cross-sectional analyses of baseline associations. Consecutive patients with IBS completed validated questionnaires assessing gastrointestinal symptoms, psychological comorbidities, and health-related quality of life. Patients were classified by bloating frequency (≥ 1 day/week vs. < 1 day/week). Between-group comparisons and multivariable logistic regression were performed. RESULTS:among 443 patients classified using the operationalized Rome V algorithm, 211 (47.6 %) reported abdominal bloating ≥1 day/week. Compared with those with less frequent bloating, these patients had greater IBS symptom severity and more frequent functional dyspepsia overlap and food-related symptoms (all p < 0.05). They also showed higher psychological comorbidity across five domains (anxiety, depression, gastrointestinal-specific anxiety, somatic symptom, and perceived stress, all p < 0.001), poorer quality of life (p < 0.001), and more gastroenterology clinic and emergency department visits (p < 0.001 and p = 0.022, respectively). On multivariable logistic regression, functional dyspepsia overlap and higher gastrointestinal, anxiety, and somatic symptom burden were independently associated with weekly bloating. Sensitivity analyses restricted to patients meeting the Rome IV criteria yielded similar findings. DISCUSSION:abdominal bloating ≥1 day per week affects nearly half of patients with operationalized Rome V IBS and is associated with greater symptom severity, higher psychological burden, poorer quality of life, and increased healthcare utilization. Assessing bloating frequency may help identify patients with greater clinical burden.
Follicular cholangitis is a rare entity that may closely mimic cholangiocarcinoma, leading to high-impact therapeutic decisions. We report the case of a 50-year-old woman with asymptomatic cholestatic liver enzyme abnormalities whose imaging studies were initially interpreted as infiltrating intrahepatic cholangiocarcinoma. However, histopathological examination of the surgical specimen established the diagnosis of follicular cholangitis. Persistence of cholestatic liver enzyme abnormalities after surgery prompted the initiation of immunosuppressive therapy, resulting in a favourable clinical and biochemical response. This case highlights the diagnostic challenges posed by follicular cholangitis and suggests that the inflammatory process may extend beyond the macroscopically identifiable lesion.
Colonic involvement by non-Hodgkin lymphoma is uncommon and can closely mimic colorectal adenocarcinoma on endoscopic and radiological grounds. We report the case of a 56-year-old woman presenting with abdominal pain and anemia, in whom colonoscopy revealed a large cecal mass extending into the ascending colon. Histological and immunohistochemical evaluation confirmed diffuse large B-cell lymphoma of non-germinal center phenotype. Staging studies revealed extensive nodal involvement, including supradiaphragmatic lymphadenopathy, establishing stage IV disease inconsistent with a strictly primary colorectal lymphoma. Systemic immunochemotherapy (R-CHOP) was initiated; after four cycles, a partial response was observed on analytical and radiological grounds, without the need for surgery to date. This case highlights the diagnostic challenge posed by bulky cecal masses mimicking colorectal cancer and underscores the importance of adequate biopsy, immunophenotypic characterization, and complete staging to guide appropriate multidisciplinary management.
Gastric metastasis from clear cell renal cell carcinoma is uncommon and may mimic a primary gastric neoplasm. We report a man in his late sixties with a 0.6-cm reddish protruding gastric lesion initially interpreted as fundic gland-type adenocarcinoma, mainly on the basis of morphology and an initial immunohistochemical panel. Targeted forceps biopsy showed small nests of tumor cells in the lamina propria. Endoscopic submucosal dissection, performed under the working diagnosis of early primary gastric neoplasia, showed no residual malignancy, probably because the minute focus had been largely removed by biopsy. Subsequent nephrectomy confirmed clear cell renal cell carcinoma. Additional immunohistochemistry of the gastric biopsy showed PAX8, CAIX, CK8/18, partial CD10 and focal RCC marker positivity, supporting gastric metastasis. This case highlights the importance of renal-lineage immunohistochemistry in small gastric lesions with unusual morphology.
Eosinophilic gastrointestinal disorders (EGIDs) comprise a group of rare diseases characterized by eosinophilic infiltration of the gastrointestinal tract exceeding that observed under physiological conditions. Non-esophageal EGIDs are uncommon, with an estimated prevalence of 1-20 cases per 100,000 individuals, and the majority of reported cases occur in adolescent males. We describe a rare case of eosinophilic gastroenteritis most likely associated with egg allergy in a 70-year-old patient. Implementation of an egg-elimination diet resulted in complete clinical remission and marked improvement in laboratory parameters, including peripheral eosinophil counts and total as well as egg-specific IgE levels. Significant reductions were also observed in IgE sensitization to egg white, egg yolk, and major egg allergens, including ovalbumin and ovomucoid. To our knowledge, only a few cases of eosinophilic gastroenteritis have been reported in elderly patients, and no cases associated with food allergy in this age group have been identified in the published literature.
The Spanish Society of Gastroenterology (SEPD) has developed a position paper on the strategic analysis of the gastroenterology specialty in relation to the current situation and future outlook of the Spanish healthcare system. The analysis and its proposals were based on the consensus of a group of experts with recognized expertise in the specialty, selected by the ESG, who conducted an external and internal analysis and developed the SWOT and CAME matrices to identify strategic lines and general objectives for the gastroenterology specialty. As a result of this analysis, six strategic lines were defined: 1. to develop the concept of "comprehensive digestive health"; 2. to contribute to the transformation of the healthcare system towards a model of care that more effectively achieves the "quintuple aim"; 3. to adapt the training of gastroenterology specialists to current needs, both in specialty training and in continuing professional development; 4. improve the quality of digestive healthcare; and 5. ensure an adequate level of quality across all centres and regions, promote research and innovation, and 6. To position the gastroenterology specialty as a reference for healthcare policy decision-making and for the society. These strategic priorities should help position the specialty of Gastroenterology as a key area for public health, technological innovation, quality of care, and the sustainability of the Spanish National Health System.
INTRODUCTION:Perianal fistulizing disease in Crohn's disease (CD) is associated with a marked impairment in quality of life. Currently, there are no Spanish-validated disease-specific instruments available to assess this impact. The aim of this study was to cross-culturally adapt and perform an initial psychometric validation of the Crohn's Anal Fistula Quality of Life (CAF-QoL) scale in a Spanish-speaking population with CD and perianal fistulas. MATERIALS AND METHODS:The original questionnaire was translated and back-translated following international guidelines for cross-cultural adaptation. The Spanish version (Sp CAF-QoL) was then administered in a prospective cohort of patients with CD and perianal fistulas, together with four validated questionnaires assessing quality of life and disease activity. Internal consistency (Cronbach's alpha and McDonald's omega), test-retest reproducibility (Lin's concordance correlation coefficient and Bland-Altman analysis), and convergent validity (Pearson correlations) were evaluated. RESULTS:Of 178 patients contacted, 94 completed the questionnaire and 60 completed the test-retest assessment four weeks later. The scale showed excellent internal consistency (α = 0.971; ω = 0.947). Lin's concordance correlation coefficient for the global score was 0.812, indicating moderate-to-good reproducibility. Moderate correlations were observed with the IBDQ-9, HADS, and PROMIS instruments, confirming adequate convergent validity. CONCLUSIONS:The Sp CAF-QoL appears to be a valid and reproducible Spanish version of the CAF-QoL for initial use in clinical and research settings. However, multicenter validation studies are still required, as well as assessment of responsiveness to clinical change and determination of the minimal clinically important difference.
INTRODUCTION:The scarcity of donor organs necessitates the development of refined prognostic tools to optimize candidate selection and survival outcomes for patients with hepatocellular carcinoma (HCC) who receive liver transplantation. Standard computed tomography scans provide additional health indicators that reveal physiological vulnerabilities beyond tumor staging. In this observational cohort study with retrospective patient inclusion and prospective follow-up, we evaluated the effects of new computed tomography-derived biomarkers, with artificial intelligence (AI)-assisted sarcopenia assessment, on the survival of patients with hepatocellular carcinoma undergoing liver transplantation. METHODS:We used preoperative chest and abdominal computed tomography scans to measure: 1. AI-assisted sarcopenia assessment; 2. myosteatosis; 3. osteoporosis, that although tomography diagnosis has been recently validated in other cohorts, it has not yet been assessed in survival of HCC patients undergoing transplantation; and 4. thymic fatty infiltration, a novel imaging biomarker of immunosenescence, that thus far has not been studied in the transplant setting. Survival analysis was performed using Kaplan-Meier curves and multivariable Cox regression models with stepwise selection. RESULTS:Sarcopenia, myosteatosis, osteoporosis, and thymus fatty replacement occurred in 35.4%, 51.3%, 27.3% and 82.1% of patients, respectively. The presence of microvascular invasion (HR= 1.943, p=0.0003), myosteatosis (HR=3.182, p=0.0001), osteoporosis (HR=2.133, p=0.0004), and thymic fatty replacement (HR=4.613, p=0.0001) independently were associated with a higher risk of mortality. While sarcopenia was significantly associated with survival in univariate (Kaplan-Meier) analysis (p=0.0002), it was not retained as an independent predictor in the final multivariable Cox model. CONCLUSION:These opportunistic imaging biomarkers provide significant noninvasive prognostic value, suggesting they may complement existing risk models and enhance the comprehensive assessment of patients undergoing liver transplantation. However, our findings require multicenter validation before integration into clinical workflows.
Colonic diverticular bleeding (CDB) is the most common cause of lower gastrointestinal bleeding. Endoscopic hemostasis plays a critical role in the management of CDB; however, even after initially successful hemostasis, CDB is still associated with a high rebleeding rate. We report a case of CDB successfully managed with a combination of thermal coagulation and clipping. For selected cases, this combined approach may help reduce the risk of recurrence of CDB.
BACKGROUND:Semiannual ultrasound is the recommended technique for hepatocellular carcinoma surveillance in patients with chronic liver disease. The aim of this study was to analyze the factors associated with ultrasound quality in routine clinical practice. METHODS:A prospective cross-sectional study was conducted in patients enrolled in a surveillance program. Demographic variables, etiology, body mass index (BMI), and waist circumference were collected. Technical limitations were recorded, and ultrasound assessment of abdominal fat distribution was performed. Quality was classified according to US LI-RADS. RESULTS:240 patients were included (70.4% male; mean age 65 years). Mean BMI was 28.9 kg/m² (SD 4.9). Obesity was present in 23.4% and abnormal waist circumference in 56.3%. The main etiologies were alcohol-related liver disease (42.1%) and metabolic dysfunction-associated steatotic liver disease (19.6%). Ultrasound quality was classified as VIS A in 42.9%, VIS B in 48.3%, and VIS C in 8.8%. Meteorism was the most frequent limiting factor (51.7%). Higher BMI and waist circumference were associated with progressively poorer visualization (p<0.001). Preperitoneal visceral fat thickness differed significantly across VIS categories (p<0.001), whereas subcutaneous fat thickness did not show significant overall differences (p=0.052). In multivariable analysis, waist circumference was the only independent predictor of impaired visualization (OR 1.074 per 1-cm increase, 95% CI 1.047-1.103; p < 0.001). CONCLUSIONS:More than half of ultrasound examinations showed moderate or severe visualization limitations, mainly associated with measures of central adiposity. Incorporating simple anthropometric measures, particularly waist circumference, may help identify patients at risk of suboptimal visualization and support a more individualized surveillance strategy.
The epidemiological landscape of hepatocellular carcinoma (HCC) is shifting from viral-dominated etiologies toward metabolic dysfunction-associated steatotic liver disease (MASLD). While the majority of cases still occur within the context of cirrhosis, approximately 20% of HCCs now arise in non-cirrhotic livers (NC-HCC). The prospective multicenter Spanish study by Romero-Gutiérrez et al. provides a timely analysis of this cohort, revealing that while surgical outcomes are favorable, long-term survival is heavily influenced by two factors: pathological aggression and patient lifestyle.
BACKGROUND:Open hemorrhoidectomy remains the gold standard for the surgical treatment of hemorrhoidal disease but is associated with substantial postoperative pain and complications. In contrast, Laser Hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative. This study aimed to evaluate the clinical outcomes, complication and recurrence rates of LHP in a single-center cohort. METHODS:This retrospective study included 132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease who underwent Laser Hemorrhoidoplasty in our center between January 2021 and June 2025. Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed. Univariable and multivariable logistic regression analyses were performed to identify associations with recurrence and complications. RESULTS:Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month. Most patients (94.7 %) were discharged on the day of surgery, and 95.5 % reported satisfaction with the postoperative outcome. Postoperative complications occurred in twelve patients (9.1 %), including three readmissions (2.3 %) and one reintervention (0.8 %). Overall recurrence occurred in thirteen patients (9.8 %), while five patients (3.8 %) required surgical treatment. Higher hemorrhoidal grade was significantly associated with recurrence, whereas no association was observed with postoperative complications. In multivariable analysis, grade IV hemorrhoids were independently associated with increased odds of recurrence after adjustment for age and previous treatment. CONCLUSION:Within this cohort, LHP may represent a safe and minimally invasive treatment option for hemorrhoidal disease associated with generally low postoperative pain, favorable patient satisfaction and relatively short hospital stay. Complication and readmission rates were low. However, grade IV disease was independently associated with increased recurrence after adjustment for age and previous treatment, indicating that caution is warranted in this subgroup. Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed to better define the role of LHP in advanced hemorrhoidal disease.
