A doença extramamária de Paget é uma malignidade cutânea rara que afeta as áreas com uma elevada concentração de glândulas apócrinas, incluindo a pele genital, axilas e ânus. Esta doença pode estar associada a um carcinoma subjacente nos órgãos adjacentes, sendo que as lesões perianais são mais frequentemente associadas a carcinomas anais ou colorretais. Sendo frequentemente diagnosticada tardiamente, esta patologia é também um desafio terapêutico.

Apresenta-se o caso de um homem de 58 anos que recorreu ao Serviço de Urgência por melenas.Trata-se de um doente com múltiplos factores de risco cardiovascular, sob clopidogrel, com doença renal crónica em pré-diálise, submetido a nefrectomia direita em 2013 por carcinoma renal de células claras (pT1bR0), sem evidência de recidiva desde então. Negava toma de anti-inflamatórios não esteróides.

Mulher de 86 anos com história pregressa de fibrilhação auricular hipocoagulada com rivaroxabano, doença renal crónica, anemia crónica não investigada e consumo frequente de AINEs, recorreu ao Serviço de Urgência por melenas e astenia com 24h de evolução.

Gastric varices are present in 20% of patients with portal hypertension and are more common in patients with non-cirrhotic portal hypertension. The bleeding rate of gastric varices is lower comparing to esophageal varices. Nevertheless, bleeding is usually more severe and associated with higher mortality rates. The role of endoscopic management of gastric varices, particularly in the setting of prophylaxis, is debatable. Endoscopic variceal obliteration (EVO) with cyanoacrylate is the preferred endoscopic approach for acute bleeding episodes, as well as for primary or secondary prophylaxis. Trials comparing EVO with elastic band ligation (EBL) have suggest a higher effectiveness of EVO and significant rebleeding rates with elastic band ligation. However, current clinical practice is supported by very low-quality evidence.

A 56-year-old woman was referred to the gastroenterology outpatient clinic due to the detection of a heterogeneous low-attenuating mass with delayed enhancement on contrasted computed tomography, located in the head of the pancreas, with 25mm of maximum diameter. The remainder pancreatic parenchyma was normal, the hepatobiliary ductal system was not dilated and no abdominopelvic adenopathies were present.

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.

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.

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.

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.

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.