El hepatoblastoma del adulto es una patología inusual, de patogenia no bien conocida y de muy mal pronóstico. Presentamos un caso de hepatoblastoma del adulto tratado en nuestro centro.Varón de 65 años, sin hepatopatía previa, que consulta por dolor en hipocondrio derecho de evolución subaguda. El diagnóstico anatomopatológico fue hepatoblastoma epitelial del adulto, con bordes quirúrgicos libres. Fue reintervenido 5 meses después por recidiva precoz y falleció 10 meses después del diagnóstico por nueva recidiva masiva. Su diagnóstico definitivo es histológico. La cirugía radical ofrece el único tratamiento que aumente la supervivencia, pero frecuentemente recidiva. No existen pautas bien definidas de quimioterapia adyuvante, ni experiencia en trasplante.Palabras clave. Hepatoblastoma. Tumores hepáticos primarios. Adulto. abstRactAdult hepatoblastoma is a rare pathology. Its pathogeny is not well understood and prognosis is very bad. We present a case of adult hepatoblastoma treated in our centre.A 65 year-old male, without previous hepatopathy, who consulted due to right hypochondrial pain with a subacute evolution. The pathological diagnosis was adult epithelial hepatoblastoma, with free surgical margins. The patient received a second surgical intervention 5 months later due to early recurrence and died 10 months after the diagnosis due to a new massive recurrence. His definitive diagnosis is histological. Radical surgery is the only treatment that increases survival, but recurrence is frequent. There are no well-defined patterns of adjuvant chemotherapy nor is there any transplant experience.

Hernia pathology accounts for a large percentage of urgent surgical interventions. Obturator hernia is rare, usually presenting as a picture of acute intestinal occlusion. The aim of the study is to analyze the experience in a third level hospital in the diagnosis and treatment of obturator hernia, as well as to detect those signs that allow an early diagnosis. This is a prospective observational study, which included patients operated on urgently for obturator hernia between 2000 and 2016. For the registration of postoperative morbidity, the Clavien-Dindo classification was used. We identified twelve patients with intestinal obstruction secondary to obturator hernia. All of them were operated on urgently. Urgent midline laparotomy was carried out on 59% of them, infraumbilical laparotomy on 33%, and a posterior inguinal approach was realized on only one patient (8%). In eight patients (67%) it was necessary to perform intestinal resection. Repair was performed by polypropylene mesh in six patients (50%), by plugging in two (17%) and closing with loose stitches in four patients (33%). Four of them presented postoperative complications, recording a single exitus secondary to perforation due to intestinal suffering. Obturator hernia is a rare entity that develops mostly as an occlusive condition in elderly women. The imaging technique of choice for diagnosis is computed tomography. Establishing an early diagnosis and urgent surgical treatment is a priority to reduce associated morbidity and mortality.

La colangiografía endoscópica retrógrada (CPRE) asociada a esfinterotomía es un procedimiento útil ampliamente utilizado en casos de coledocolitiasis y obstrucción de la vía biliar. A pesar de tratarse de una prueba segura, existe el riesgo de complicaciones tales como la pancreatitis, la hemorragia o la perforación.La perforación duodenal post CPRE es un hecho poco común pero de graves consecuencias de no ser tratado precozmente. El mecanismo de lesión, el lugar y extensión de la perforación así como la clínica y los hallazgos radiográficos guiarán el manejo del paciente, que debe ser individualizado y en constante reevaluación.Su mortalidad se relaciona de manera estrecha con el retraso diagnóstico y terapéutico. En aquellos en los que se decida una actitud conservadora, se mantendrá una vigilancia estrecha ante la posibilidad de empeoramiento clínico y cambio en su manejo.Palabras clave: Perforación intestinal, Perforación duodenal, Colangiopancreatografía, Endoscopia retró-grada. aBstRactEndoscopic retrograde cholangiopancreatography (ERCP) associated with sphincterotomy is a useful procedure that is widely used in cases of choledocholithiasis and bile duct obstruction. In spite of being a safe test, there is a risk of complications like pancreatitis, haemorrhaging or perforation.Post-ERCP duodenal perforation is a rare event but has serious consequences if it is not treated early. The lesion mechanism, the place and extension of the perforation, as well as the clinical picture and radiographic findings will guide patient management, which must be individualised and constantly reevaluated.Its mortality is closely related to diagnostic and therapeutic delay. In those cases where a conservative attitude is adopted, close vigilance will be maintained facing the possibility of a worsening of the clinical picture and a change in its management.