Introducción. El síndrome de HELLP es una variante grave de la preeclampsia, con una baja incidencia, entre el 0,5-0,9 % de todos los embarazos. La ruptura hepática espontánea en el embarazo es infrecuente, presenta una alta mortalidad, y se ha relacionado con hemangiomas hepáticos, coriocarcinoma y síndrome de HELLP.
Caso clínico. Mujer de 29 años con embarazo de 34,3 semanas, con actividad uterina progresiva, sufrimiento fetal agudo y hallazgos compatibles con síndrome de HELLP. Se practicó cesárea de urgencia encontrando hemoperitoneo y ruptura hepática del lóbulo derecho, por lo que se realizó empaquetamiento abdominal y posterior reintervención quirúrgica.
Discusión. La ruptura hepática espontánea en el embarazo es una entidad infrecuente y potencialmente mortal. Es esencial un alto nivel de sospecha para realizar el diagnóstico y la rápida intervención. Requiere un manejo multidisciplinario para un resultado exitoso. Se han descrito múltiples tratamientos que dependen de las manifestaciones clínicas y extensión de la lesión, pero es claro que la laparotomía primaria y el taponamiento constituyen la mejor elección ante el hallazgo intraoperatorio
The increasing prevalence of obesity is not only observed in adults. Children are affected by obesity and related diseases, such as chronic liver disease, more frequently than in the past. Nonalcoholic fatty-liver disease is an important cause of chronic liver disease and in the near future will become important worldwide. Considering this phenomenon, it is important for gastroenterologists and hepatologists to be aware of the presence of nonalcoholic fatty-liver disease in pediatric populations and to treat it adequately. This practice will have important benefits for future generations. This review discusses the most important aspects in epidemiology, diagnostics and treatment of nonalcoholic fatty-liver disease in children.Abbreviations: ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index; DM2 = type 2 diabetes mellitus; FFA = free fatty acids; HOMA-IR = homeostasis model assessment insulin resistance; IL-6 = interleukin 6; NAFLD = non-alcoholic fatty liver disease; NASH = non-alcoholic steatohepatitis; PPAR = peroxisome proliferator-activated receptors; QUICKI = quantitative insulin-sensitivity check index; TGF = tumor growth factor; TNF= tumor necrosis factor; UDCA = ursodeoxycholic acid; US = ultrasound.
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