Defectos de cierre de la pared abdominal: gastrosquisis / Abdominal wall defects: gastroschisis

Objetivo. La gastrosquisis es un defecto de la pared abdominal, a nivel paraumbilical generalmente derecho, que cursa con la extrusión libre de las asas intestinales. El contacto de estas con sustancias irritantes presentes en el líquido amniótico condiciona la lesión intestinal, factor más importante en el pronóstico neonatal. Métodos. Su incidencia se ha visto incrementada en los últimos años quizás por la mejora en las tasas de diagnóstico prenatal. El diagnóstico y seguimiento por ultrasonidos han permitido anticiparse a sus complicaciones, causa principal de morbimortalidad en estos casos. Por ello es muy importante llevar a cabo un plan diagnóstico-terapéutico que coordine al obstetra, al pediatra y al cirujano pediátrico. Conclusión. Este estudio se ha llevado a cabo con el fin de revisar y analizar en la bibliografía existente los puntos más controvertidos en el seguimiento y tratamiento de esta patología, además de mostrar los resultados obtenidos en nuestro centro en los últimos años (AU)

Objetive. Gastroschisis is an abdominal wall defect, usually located to the right of the umbilical cord insertion, leading to freely floating bowel loops outside the fetal abdomen. Contact with irritants in the amniotic fluid causes the intestinal injury, the most important factor in neonatal outcome. Methods. The incidence of this entity has increased in recent years, possibly due to improved prenatal diagnosis rates. Ultrasound diagnosis and monitoring have allowed the prevention of complications, the main cause of morbidity and mortality in these cases. Therefore, a therapeutic-diagnosis plan to coordinate the obstetrician, pediatrician and pediatric surgeon is of the utmost importance. Conclusion. This study was conducted to analyze the most controversial issues in the monitoring and treatment of this defect, and to compare the results obtained in our center with those reported in the literature (AU)

[Angiomyolipomas, tuberous sclerosis and pregnancy]. / Angiomiolipomas, esclerosis tuberosa y gestación.

Renal angiomyolipomas are uncommon tumours during pregnancy, but it's important to consider them in the differential diagnosis, for the increased risk of complications such as bleeding, specially during pregnancy. Their characteristics are different depending on if the tumour is associated or not with facomatosis. To show both possibilities, we describe two cases of pregnant women with angiomyolipomas: the first one presented with bleeding of the tumour (Wünderlich's syndrome), but surveillance without treatment was possible until 37th week of gestation, and embolization of the tumour was performed afterwards. The second patient had multiple well known angiomyolipomas, associated to tuberous sclerosis; even though she had required two previous embolizations, she had an uneventful pregnancy, without any episodes of bleeding. Both pregnancies ended successfully by means of a cesarean section. Since there are few papers available in the literature, there is not an agreement about therapeutic management when pregnant women present with bleeding angiomyolipomas (Wünderlich's syndrome). Treatment options include partial or total nephrectomy (with cesarean section simultaneously in patients at 28 weeks of gestation or later), transcateter selective arterial embolization (which can also be preventive), and sometimes, conservative management. If this last option is possible, there's still discussion about the risk of vaginal delivery compared with that of cesarean section, in terms of bleeding of the tumour.