Management of biliary lithiasis in pregnancy – an updated overview

Abstract

It is estimated that 2% of pregnant women develop gallstones during pregnancy. Symptoms of biliary lithiasis may vary during pregnancy, from a slight added digestive discomfort to biliary colic of varying intensity, acute cholecystitis, or acute pancreatitis. Ultrasonography is the gold standard for diagnosis of sludge and gallstones, being both highly sensitive and specific. Initial management overlaps with the out-of-pregnancy management, initiating conservative, supportive care, as well as an adequate diet. Laparoscopic cholecystectomy is considered a safe intervention in pregnancy, being the second most common surgery after appendicectomy. If open laparoscopy is preferred, the major risk - perforation of the uterus - is avoided. Important complications of gallstones in pregnancy, jaundice and acute pancreatitis can be resolved safely and quickly by cholangiopancreatography (ERCP) techniques, with stone removal, sphincterotomy or stent mounting. After remission of pancreatic symptoms, laparoscopic cholecystectomy can be performed. Recent scientific data and current practice suggest an increase of biliopancreatic emergencies during pregnancy (probably due to rising incidence of obesity, age of gravida, prolonged use of oral combined contraceptives, dyslipidemia, etc.). Surgeons, as well as obstetricians, should be aware of the prompt modern management of these cases.

Review on Common Non-Obstetric Acute Abdominal Conditions in Pregnancy: An Update of Management

“…Elevated total white cell counts, and C. Reactive protein are all features of acute cholecystitis but in pregnancy the physiological elevation of these parameters makes the diagnosis of acute cholecystitis in pregnancy difficult. Ultrasound is the initial investigation of choice in acute cholecystitis in pregnancy and it can detect gallstones and inflammation of the gallbladder [33][34][35][36].…”

A Narrative Review on Acute Cholecystitis in Pregnancy: Current Update on Management

“…Medical treatment involves admitting the patients, keeping them fasted, starting intravenous antibiotics and analgesics and once the patient's condition had improved, cholecystectomy was often planned during the post-partum period. If a cholecystectomy needs to be done during the pregnancy it is usually performed during the second trimester, with surgery not performed during the first and third trimester due to the risk of threatened abortion and the size of the gravid uterus [6][7][8] Patients who undergo conservative treatment for acute cholecystitis in pregnancy often have a high readmission rate due to recurrent attacks and this can affect the wellbeing of the mother and the fetus. This has been the reason for performing the cholecystectomy earlier to manage this condition [9].…”