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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Clinically significant hemorrhagic complications associated usually to previous papillotomy are uncommon. Subcapsular hepatic hematoma is excepcional, with only twenty cases described. We present a case of a 52-year-old man who developed a large subcapsular liver hematoma following a therapeutic ERCP. Due to serious anemization and hemodynamic instability, arterial embolization and finally urgent surgical evacuation of the hematoma were performed. In the postoperative period the patient presented infection of the collection, which indicated colocation of percutaneous drainage and broad-spectrum intravenous antibiotics, and gradually recovered.

The name of the 14th author F. Koeckerling is misspelled. The correct spelling is F. Köckerling.

Background: the ischemic colitis is intestinal the most frequent cause of ischemia. With this work we determine the demographic and clinical characteristics, and the usefulness of the colonoscopy in the patients with ischemic colitis diagnosed in our centre in relation to a change of therapeutic attitude.Method: retrospective study in which were selected 112 patients diagnosed with ischemic colitis by colonoscopy and biopsy, in a period of five years. It was analyzed: age, sex, reason for examination, factors of cardiovascular risk, endoscopic degree of ischemia, change in the therapeutic attitude, treatment and outcome.Results: the average age was of 73.64 ± 12.10 years with an equal incidence in women (50.9%) and the men (49.1%). The associated factors were the HTA (61.1%), tobacco (37.2%) and antecedents of cardiovascular episode (52.2%). The most frequent reason for colonoscopy was rectorrhagia (53.6%) followed of the abdominal pain (30.4%), being urgent the 65.3%. Colonoscopy allowed a change in the therapeutic attitude in the 50 increasing in the urgent one to the 65.75%. Global mortality was of 27.67%. The serious ischemic colitis (25%) was more frequent in men (64.3%) in urgent indication (85.71%) and attends with high mortality (53.57%). Surgical treatment in the 57.14% was made with a good evolution in the 50%, whereas the patients with mild or moderate ischemic colitis had a better prognosis (favourable evolution in 80.95%) with smaller requirement of the surgical treatment (4.76%), p < 0.05.Conclusion: the colitis ischemic are more frequent in the older age. The most frequent symptoms are the rectorrhagia and the abdominal pain. The colonoscopy is a useful technique to evaluate the gravity and it induces a change of attitude according to the result of the same one. The evidence of a serious colitis supposed an increase of the necessity of surgery and worse prognosis.

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TIPS with the Strecker stent is a safe alternative for variceal bleeding. Shunt dysfunction is frequent and increases the rebleeding rate, requiring a close follow-up with pressure measurements. Randomized trials comparing stents and other alternatives are needed to fully address the role of this procedure.

A 74-year-old man with a previous history of surgery for pharyngolaryngeal neoplasia and reconstruction in 2006 with muscle graft was referred to our unit for dysphagia. Upper endoscopy showed a narrow stricture at the muscle graftesophageal anastomosis that was 20 mm long. The patient underwent five sessions of esophageal dilation with the CRE Balloon Dilator (Boston Scientific, Natick, Massachusetts, USA) with early relapse and weight loss. Therapeutic options were discussed with the patient, and we decided to place an 80-mm SX-ELLA Esophageal Degradable BD stent (ELLA-CS, Hradec Králové, Czech Republic). It was placed under fluoroscopic guidance without complications. The patient presented an initial improvement from dysphagia grade 4 to dysphagia grade 2, but after 9 weeks he attended the emergency ward for aphagia. An urgent upper endoscopy was performed showing a collapse of the biodegradable stent mesh inside the esophageal lumen (• " Fig. 1); the collapsed mesh did not allow the passage of a standard Pentax endoscope. A foreign body forceps was used to remove the filaments of partially reabsorbed polydioxanone mesh until a clear lumen was obtained that allowed easy passage of the endoscope (• " Fig. 2). The patient was discharged from hospital the next day with an improvement of his dysphagia.

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