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Gastric ischemia (GI) results from diffuse or localized vascular insufficiency caused by different aetiologies such as systemic hypotension, vasculitis, disseminated thromboembolism and celiac or mesenteric stenosis. We present a case of gastric ischemia due to critical stenosis of the celiac artery treated using endovascular therapy. The celiac artery is the first major branch of the abdominal aorta and provides some of the blood supply to the stomach through the left gastric artery and other organs like the spleen (splenic artery branch) and the liver. Although the collateral blood supply to the stomach is protective, systemic hypotension or occlusion of the main arteries, as in the case of our patient, may result in gastric ischemia. The stent placement is an alternative to surgery in patients with high comorbidity and with good outcomes. The clinical awareness of this syndrome will allow gastroenterologists and radiologists to appropriately diagnose and manage affected patients. RESUMEN La isquemia gástrica resulta de la insuficiencia vascular difusa o localizada causada por diferentes etiologías como la hipotensión sistémica, la vasculitis, el tromboembolismo diseminado y la estenosis mesentérica o celíaca. Presentamos un caso de isquemia gástrica secundaria a estenosis crítica del tronco celíaco tratada endovascularmente. El tronco celíaco es la primera rama de la aorta abdominal y aporta gran parte del flujo de sangre al estómago a través de la arteria gástrica izquierda y de otros órganos como el bazo (a través de la rama esplénica) y el hígado. Aunque las colaterales que irrigan el estómago son protectoras, la hipotensión sistémica o la oclusión de las principales ramas como en el caso que presentamos, pueden llevar a la isquemia gástrica. La colocación de stents endovasculares es una alterativa terapéutica a la cirugía en pacientes con gran comorbilidad y con buenos resultados. La sospecha clínica de este síndrome puede llevar tanto a gastroenterólogos como a radiólogos a un correcto diagnóstico y tratamiento de los pacientes afectos.

Nowadays, capsule endoscopy is the first-line procedure for the visualization of the small bowel. Although it was primarily designed with this goal, it may also identify other segments of the gastrointestinal tract. The aim of the current study is to evaluate the incidence of esophageal abnormalities detected in patients undergoing small bowel capsule endoscopy and its impact on patient management.This study is a retrospective analysis of data from 2217 consecutive capsule endoscopy procedures performed at a single tertiary-care centre between January 2008 and February 2016. Patient baseline characteristics, esophageal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was then performed.2217 patients were finally included in the analysis. 1070 were male (48.2%) and the mean age was 56.1 ± 19.5 years (12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Esophageal abnormalities were detected in 105 out of 2217 patients (4.7%). The most common lesions detected were peptic esophagitis (58.1%) and esophageal varices (17.1%). This information had a clinical/diagnostic impact of 3.3% and a therapeutic impact of 3.2%.Capsule endoscopy detects not only small bowel lesions, but also significant esophageal lesions that may be overlooked during initial gastroscopy. Therefore, all images of the esophagus should be read during small bowel capsule endoscopy, since it could provide relevant information that may result in changes on patient´s management.

La hemorragia digestiva de origen oscuro constituye el 5-10% del total de hemorragias digestivas, siendo el intestino delgado la localización más frecuente. Por su sencillez y fiabilidad la enteroscopia con cápsula es la técnica de elección tras un primer estudio endoscópico negativo (gastroscopia e ileo-colonoscopia). Sin embargo, en ocasiones, el origen del sangrado no se identifica en el interior de éste, sino fuera y al alcance de la endoscopia convencional (esófago, estómago o colon). Presentamos el caso de un paciente de 46 años con anemia ferropénica y varios estudios endoscópicos previos negativos a quien se detectó un tumor gástrico (GIST) durante una enteroscopia con cápsula. El diagnóstico definitivo se obtuvo tras el estudio histológico de la pieza quirúrgica. Obscure gastrointestinal bleeding accounts for approximately 5-10% of patients presenting with gastrointestinal haemorrhage. The majority of lesions responsible were found to be located in the small bowel. Currently, capsule endoscopy is the first-line tool to investigate the small bowel as it is a non-invasive, feasible and simple procedure. However, capsule endoscopy sometimes identifies the source of bleeding outside the small bowel and within the reach of conventional endoscopy. We present the case of a 46 year-old man with few prior negative endoscopic procedures and iron-deficiency anaemia due to gastric GIST.

La hemorragia digestiva de origen oscuro constituye el 5-10% del total de hemorragias digestivas, siendo el intestino delgado la localización más frecuente. Por su sencillez y fiabilidad la enteroscopia con cápsula es la técnica de elección tras un primer estudio endoscópico negativo (gastroscopia e ileo-colonoscopia). Sin embargo, en ocasiones, el origen del sangrado no se identifica en el interior de éste, sino fuera y al alcance de la endoscopia convencional (esófago, estómago o colon). Presentamos el caso de un paciente de 46 años con anemia ferropénica y varios estudios endoscópicos previos negativos a quien se detectó un tumor gástrico (GIST) durante una enteroscopia con cápsula. El diagnóstico definitivo se obtuvo tras el estudio histológico de la pieza quirúrgica.

Fundamento. El hepatocarcinoma asienta generalmente sobre una cirrosis hepática. El cribado pretende mejorar la supervivencia. Los objetivos de nuestro trabajo son conocer las características del hepatocarcinoma, su evolución y la influencia del cribado en su supervivencia, en la práctica clínica en Navarra. Material y Métodos. Estudio prospectivo y retrospectivo de 111 pacientes diagnosticados de hepatocarcinoma en hospitales públicos navarros, entre enero de 2009 y enero de 2015. Se analizaron características epidemiológicas, clínicas, analíticas, radiológicas, estadio tumoral, tratamiento y evolución, y el efecto del cribado. Resultados. El 84,7% de los pacientes eran varones. La edad media fue 67 años. El 85,6% tenían cirrosis. La etiología más frecuente fue la enólica (40,7%). El 62,2% se diagnosticó en estadios tempranos, el 15,3% en intermedio y el 22,5% en avanzado o terminal. El 4,5% se trató mediante trasplante, el 21,6% con resección, el 23,4% mediante ablación, el 10,8% con quimioembolización, el 5,4% con radiembolización, el 2,7% con embolización, el 13,5% con sorafenib y el 18% de modo sintomático. Solamente 32 pacientes (28,8%) realizaban cribado. No se han encontrado diferencias significativas en la supervivencia según la realización de cribado (mediana de 32 y 34 meses; p = 0,971). Conclusiones. En Navarra, el hepatocarcinoma se desarrolla generalmente sobre una cirrosis, cuya etiología más frecuente es el consumo de alcohol. El hepatocarcinoma se ha diagnosticado con más frecuencia en estadios iniciales, fuera de cribado. El cribado no ha mejorado la supervivencia. Background. Hepatocellular carcinoma generally arises in a cirrhotic liver. The aim of screening is to improve survival. The aims of our study are to determine the characteristics and evolution of hepatocellular carcinoma and the effect of screening on survival, in clinical practice in Navarre. Methods. Prospective and retrospective study of 111 patients diagnosed with hepatocellular carcinoma in public hospitals in Navarre between January 2009 and January 2015. Epidemiological, clinical, analytical, radiological characteristics, tumour staging, treatment and evolution were analyzed. Survival was compared between patients subjected to screening and those not. Results. Mean age was 67 years. The patients (84.7%) were mainly male and 85.6% had cirrhosis. The most frequent aetiology was alcohol consumption (40.7%). 62.2% were diagnosed in early stages, 15.3% in intermediate and 22.5 % in advanced or terminal stages. 4.5% received transplants, 21.6% received surgical resection, 23.4% were treated with ablation techniques, 10.8 % with chemoembolization, 5.4% with radiembolization, 2.7% with embolization, 13.5 % with sorafenib and 18% symptomatically. Only 32 patients (28.8%) were subjected to screening. No statistical differences were found in survival depending on surveillance (32 month versus 34; p = 0.971). Conclusions. In Navarre, hepatocellular carcinoma generally appears against a background of cirrhosis, and alcohol is the most frequent aetiology. Hepatocellular carcinoma is diagnosed most frequently in early stages and out of screening practices. Screening was not associated to better survival.

Pericardial cysts are uncommon lesions usually found incidentally upon the radiologic investigation of some other condition. The aetiology can be both congenital and acquired (post inflammatory processes, infection or even posttraumatic). They are the most common benign tumour of the pericardium but there is still a difficulty in the differential diagnosis because even clinical or analytically are not different from some other benign or malignant lesions. Further image studies are required to complete the study of these lesions. Even the majority are asymptomatic (>50%), the localization and relation to adjacent structures lead the role of the clinical manifestations (persistent cough, dyspnoea, chest pain...). We present the case of a man with oppressive chest pain after 2 weeks of thoracic traumatism with an abnormal radiological image in the chest X-ray. Los quistes pericárdicos son lesiones poco frecuentes que se presentan como hallazgo casual en estudios radiológicos realizados por otros motivos. La mayoría son asintomáticos (>50%) pero su localización y relación con estructuras vecinas determinan las manifestaciones clínicas (tos persistente, disnea, dolor torácico...) Presentamos el caso de un paciente con dolor torácico opresivo a las dos semanas de un traumatismo torácico con una imagen sospechosa en la placa de tórax.

The choledochocele is a cystic dilatation of the intraduodenal portion of the bile duct and corresponds to the type III biliary cysts in the Todani ´s classification. Eventhough the majority of patients remain asymptomatic they can be an atypical cause of abdominal pain or relapsing acute pancreatitis events. The risk of malignancy is lower than other choledochal cyst (2,5%). The treatment is based on surgical or new endoscopic techniques of resection. In some of the cases an endoscopic sphincterotomy is the first approach.