Os fatores mais importantes para obter um estudo adequado por cápsula endoscópica do cólon (CCE) são a preparação intestinal e a expulsão da cápsula durante o seu tempo de bateria. O objetivo deste estudo foi avaliar fatores clínicos e demográficos associados a preparação intestinal inadequada em doentes submetidos a CCE, prevendo quais os doentes que irão necessitar de ajuste nos regimes de preparação intestinal.

A 82-year-old male was referred due to a 56mm nodular-mixed type laterally spreading tumour, Paris 0-Is+IIa, JNET type-2B, located in the distal rectum, extending to the anal verge.

Percutaneous endoscopic gastrostomy (PEG) tubes are commonly utilized as a method of enteral feeding in patients unable to obtain adequate oral nutrition. However, the safety and effectiveness of PEG insertion in patients with dementia remains to be defined. The aim of the study was to evaluate the nutritional effectiveness, rate of rehospitalization and risk of mortality among patients with dementia who undergo PEG placement.

A 55-year-old male underwent endoscopic submucosal dissection (ESD), under general anesthesia and orotracheal intubation, of a 22 mm Paris 0-IIa+0-IIb lesion, located in the greater curvature of the medium/distal antrum (A). It was not possible to start the procedure, after several attempts, due to permanent belching and inability to maintain adequate gastric distension. ESD was only feasible after performing the Sellick-maneuver (manual pressure application at the cricoid cartilage to occlude the upper esophagus), which allowed sustained gastric distension throughout the procedure (60 minutes).

Homem, 53 anos, submetido a hemicolectomia direita de urgência por adenocarcinoma mucinoso do apêndice (pT3N0M1 – com infiltração do mesocólon) que se apresentou sob a forma de apendicite. O pós-operatório foi pautado de oclusão intestinal secundária a peritonite adesiva, condicionando necessidade de duas abordagens cirúrgicas, a primeira exclusivamente com lise de bridas. Na segunda re-intervenção constatada estenose cerrada de jejuno e retração dos mesos, com necessidade de enterectomia segmentar de jejuno e construção de jejunostomia e fístula mucosa, em locais separados, em virtude da dificuldade de mobilização das ansas.

We present the case of a 60-year-old woman with history of hypertension, type 2 Diabetes mellitus and who was under antiplatelet therapy for cerebrovascular disease. She was referred to our institution from another hospital with a 7 day history of persistent hematochezia. Laboratory tests were significant for hemoglobin of 5.4 g/dL. She received 7U of packed red blood cells prior to transfer and underwent upper and lower endoscopy at the referring institution with no identification of the source of active bleeding.

A 55-year-old woman with cirrhosis due to primary biliary cholangitis was admitted in the setting of acute decompensation (ascites and hepatic hydrothorax) caused by portal vein thrombosis. Fifteen days after admission, she presented melena and an esophagogastroscopy was performed. Non-bleeding large esophageal varices were identified along with two gastric polyps, both with recent bleeding stigmata. One polyp, with 20 mm, was in the gastric fundus, while the other, a pseudo-pedunculated inflammatory type polyp with 35 mm and multilobulated, protruded from the posterior antral wall into the duodenal bulb. The first polyp was removed with a diathermic loop, after adrenalin injection (1:10.000). However, immediate oozing bleeding occurred, and persisted after scar closure with 4 trough-the-scope (TTS) clips. A metallic “tulip-bundle” technique, using an over-the-scope-clip, was successfully used as a rescue therapy, after a failed classic tulip-bundle using an endoloop in retroflexion. The second polyp was pulled into the stomach using a foreign body forceps, and the “ligate-and-let-go” method was applied; biopsies had been performed. At the end of the procedure, a deep mucosal laceration in the lesser curvature from barotrauma was identified and successfully closed with 8 TTS clips. The patient remained stable during and after the procedure and adjunctive therapy with a proton pump inhibitor was instituted. The histological analysis of the removed polyp revealed high grade dysplasia with focal lamina propria invasion; the ligated polyp was classified as inflammatory. No rebleeding occurred on the two months of follow-up.

Os autores relatam o caso de um homem de 20 anos, sem antecedentes pessoais de relevo, admitido por icterícia indolor com uma semana de evolução. Ao exame objetivo apresentava-se ictérico, não existindo sinais de encefalopatia, ascite ou doença hepática crónica.

Os ganglioneuromas são tumores benignos e raros do sistema nervoso simpático, com origem em células da crista neural, sendo a sua localização no trato gastrointestinal particularmente rara. Ao contrário da ganglioneuromatose polipóide ou difusa, os ganglioneuromas polipóides isolados, não estão associados com síndromes genéticos. Descreve-se o caso de uma mulher com uma lesão do cólon ascendente que revelou tratar-se de um ganglioneuroma.

Doente do sexo feminino de 54 anos recorreu ao Serviço de Urgência (SU) por dor no quadrante inferior direito do abdómen com um mês de evolução, associada a febre nos dois dias precedentes. Sem outros sintomas. Três anos antes, a doente tinha sido diagnosticada com Polipose Adenomatosa Familiar e submetida a proctocolectomia total profilática, com construção de bolsa ileal, sem complicações perioperatórias.