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Los inmunosupresores se encuentran entre los grupos farmacológicos con mayor potencial teórico de inducir reacciones adversas, entre ellas las hepáticas. Presentamos el caso de un paciente de 35 años con enfermedad de Crohn en tratamiento con azatioprina por corticodependencia al que se le diagnosticó tras realización de una biopsia hepática de hiperplasia nodular regenerativa secundaria a este tratamiento.

Cholecystocolic fistula is an uncommon biliary-enteric fistula with a variable clinical presentation that usually appears as a rare complication of gallstone disease. It can present with abdominal pain, nausea, weight loss, diarrea with or without associated steatorrhea, and dyspeptic symptoms. Rare cases have been reported with lower gastrointestinal hemorrage and even with a gallstone illeous. The most useful techniques for diagnosis are CT, barium studies, and ERCP. Although a diagnosis of cholecystocolic fistula is rarely suspected clinically, it should be considered in elderly patients with unexplained pneumobilia or unexplained persistent diarrhea. The standard treatment for these fistulas is cholecystectomy and excision of the fistula. Endoscopic sphincterotomy is an option in the treatment of elderly unfit patients as it can cause spontaneous healing of the fistula by reducing increased biliary pressure. Also, spontaneous resolution of the fistula has been described, although it is not very common. We report a case of a cholecistocolic fistula in an eldery woman with multiple medical comorbidities that presented as a lower gastrointestinal bleeding. She was explored with colonoscopy, abdominal CT and barium enema. She required a total of 4 units of whole blood and because of her comorbidities a decision was made not to proceed with invasive treatment. She had a good evolution and was asintomatic two months later.

El cistoadenoma seroso es el segundo tumor quístico más frecuente del páncreas y representa el 1-2% de todas las neoplasias exocrinas pancreáticas. Recientemente, gracias a las mejoras en las técnicas de imagen, la identificación de las lesiones quísticas pancreáticas es cada vez más frecuente. El diagnóstico diferencial ha de hacerse con el cistoadenoma mucinoso, debido al potencial maligno de esta última entidad. En esta nota clínica describimos el caso de una paciente con ictericia indolora y colestasis, con diagnóstico final de cistoadenoma seroso pancreático.

We present the case of an 85 year old male who was admitted to hospital with abdominal pain and jaundice. Different explorations were performed for this reason, with a mass observed in his 2nd duodenal portion. Histological study showed that it was a duodenal gangliocytic paraganglioma. The clinical characteristics of this infrequent tumour are described and we review the diagnosis and treatment.