Insulinoma Management in a Pregnant Woman: A Case Report.

An insulinoma is a rare tumor that originates in the ß cells of the pancreas with an incidence of four cases per million people per year. To our knowledge, 40 cases of insulinoma in pregnancy have been reported. Insulinoma in pregnancy is usually diagnosed in the first trimester. Surgical treatment is advised during the second trimester with complications arising in up to 10% of cases. We present the case of a 34-year-old pregnant woman diagnosed with insulinoma during the first trimester. The patient underwent a laparoscopic resection of the tumor at 15.5 weeks of gestation. Insulinoma was resected and postoperative complications were managed, including acute pancreatitis and peripancreatic and splenorenal fluid collection, which were treated using multidisciplinary management and resolved at the end of the pregnancy at 40.1 weeks of gestation.

Reconstrucción cervical con conexión vaginal secundaria a agenesia cervical. Reporte de caso / Cervical reconstruction with vaginal conexion secundary to cervical agenesia. Case report

Resumen ANTECEDENTES: La agenesia cervical congénita es una anomalía poco común del sistema de Müller, que generalmente se reconoce durante la menarquia. Hasta hace poco, el tratamiento de primera elección era la histerectomía, debido a que no se consideraba una enfermedad compatible con la fertilidad. Hoy en día, gracias a las técnicas de reproducción asistida, se han desarrollado procedimientos quirúrgicos menos agresivos que sí preservan la fertilidad de las pacientes. OBJETIVO: Revisar un caso de agenesia cervical a partir de su tratamiento quirúrgico y seguimiento de la reconstrucción cervical con la conexión entre la vagina y el útero, revisar la bibliografía y cómo establecer el pronóstico a largo plazo. CASO CLÍNICO: Paciente de 12 años llevada a consulta ante la ausencia de menstruación. El procedimiento diagnóstico transcurrió sin que se encontraran alteraciones; sin embargo, en la laparoscopia diagnóstica operatoria efectuada a los 14 años, indicada por dolor pélvico cíclico, se advirtieron la ausencia del cuello del útero, un hematometra y endometriosis grado IV. En el segundo tiempo quirúrgico, practicado en conjunto con el cirujano pediatra, se practicó, por laparotomía, la comunicación entre el útero y la vagina. En la actualidad, la paciente tiene 19 años y sus menstruaciones son cíclicas, no dolorosas. En el último ultrasonido se visualizó la conexión entre el útero y la vagina. CONCLUSIONES: Hoy en día, la anastomosis útero vaginal es un procedimiento capaz de mantener la función del útero y permitir el embarazo, con los cuidados adecuados.

Abstract BACKGROUND: Congenital cervical agenesis is a rare anomaly of the Müllerian system, usually recognized during menarche. Until recently, the treatment of first choice was hysterectomy, because it was not considered a disease compatible with fertility. Today, thanks to assisted reproductive techniques, less aggressive surgical procedures have been developed that do preserve the fertility of patients. OBJECTIVE: To review a case of cervical agenesis from its surgical treatment and follow-up cervical reconstruction with the connection between the vagina and the uterus, review the literature and how to establish the long-term prognosis. CLINICAL CASE: A 12 years old female patient was brought for consultation due to absence of menstruation. The diagnostic procedure was carried out without finding any alterations; however, in the operative diagnostic laparoscopy performed at the age of 14, indicated by cyclic pelvic pain, the absence of the cervix, a hematometra and endometriosis grade IV were noticed. In the second surgery, performed in conjunction with the pediatric surgeon, the communication between the uterus and the vagina was performed by laparotomy. At present, the patient is 19 years old and her menses are cyclical, not painful. In the last ultrasound the connection between the uterus and the vagina was visualized. CONCLUSIONS: Today, utero-vaginal anastomosis is a procedure capable of maintaining the function of the uterus and allowing pregnancy, with proper care.

[Ovarian cystadenoma and ectopic pregnancy. A case report]. / Cistadenoma ovárico y embarazo ectópico concomitante. Reporte de caso.

A 40-year-old woman without symptoms, with a three-week amenorrhea, and with no previous pregnancy history. Three months before she followed treatment with clomifeno and no other risk factors. A measure of beta fraction is performed, finding a probable pregnancy of 3-4 weeks. A new measure of beta fraction is made three weeks later with an ultrasound, finding an important increment in measure, but without evidence of intrauterine pregnancy in the ultrasound. A new ultrasound is made seven weeks after her last period, finding a mass in the left ovary, but without increment in beta fraction. At week ten, she presents an uterine bleeding during a trip, which is diagnosed as a probable mole without any further medical treatment and from the 12th week, there is a considerable decrement in the beta fraction measure, without any other symptom, but the persistent adnexal mass at the left ovary, with irregular septum images at ultrasound. A laparotomy is performed finding an ectopic pregnancy surrounded by a serum cystadenoma.

[Pedunculated twisted myoma and pregnancy. Case report]. / Mioma pediculado torcido en una mujer embarazada. Reporte de caso.

The detection of a pelvic mass during pregnancy is uncommon. Most of them are benigns and they usually disapear by the second trimester of gestation, or keep asintomatic until the resolution of the pregnancy. The persistence, the size and the ultrasonografic caracteristics represents a mayor concern related to the obstetrical management and the complications. We report a case of a woman at the 15 week of gestation with torsi6n of a pedunculated mioma mimicking in the ultrasonografic image an ovarian tumor.

[Placenta chorioangioma. Case report at Hospital Español]. / Corioangioma placentario. Reporte de un caso en el Hospital Español.

Placenta chorioangioma is the most frequent non-trophoblastic tumor of the placenta. Its real incidence is unknown. This incidence is reported as 1% in microscopically examined placentas and counts with clinical evidence in approximately 1: 3,500 to 9,000 births. This tumor is not generally associated to maternal fetal complications, unless the tumor size surpasses a diameter of 5 cm or is near the place of umbilical cord insertion. When the tumor is big, it can complicate the pregnancy with hydramnios, postpartum bleeding, delay in the intrauterine growth, or congestive heart failure in the newborn. The clinic case belongs to a Korean female patient, aged 32, without important antecedents. A placental tumouration, 50.2 x 44.1 mm, was detected by ultrasound to this patient in her 37 1/7 week of pregnancy. She has a normoevolutive pregnancy whose was a term, she had an a eutocic delivery, getting a male whose weight was 2,850 g. The baby is still alive. The placenta histopathological study reported placental chorioangioma, which infracted partially, with multifocal calcification areas.