Management of Acute Cholecystitis During Pregnancy: A Single Center Experience

Abstract

BACKGROUND: This study aimed to present to evaluate the results of two different approaches in the management of acute cholecystitis during pregnancy: immediate surgery and delayed surgery following conservative management. METHODS: In this study, 20 pregnant women who were treated in our clinic for acute cholecystitis between 2010 and 2018 were included in the analysis. Demographic characteristics, parameters related with acute cholecystitis (gallbladder wall thickness, laboratory data), duration of hospitalization, readmission rates, and preterm labor rate were retrospectively evaluated. RESULTS: The median age was 29.5 years. The median gestational week was 20 (6-32) weeks. Laparoscopic cholecystectomy was performed in 6 (30%) patients on admittance. When compared with the conservative management group, patients who received immediate surgery had higher gallbladder wall thickness. WBC count, and CRP, ALT, AST, ALP, and GGT levels (p<0.05). Furthermore, readmission rate and duration of hospitalization were lower in the patients who underwent immediate surgery (p<0.05). The preterm labor rate in conservative management and immediate surgery groups were 28.5% and 0%, respectively (p>0.05). CONCLUSION: In this study, even though these patients had thicker gallbladder wall and higher inflammatory markers suggesting severe inflammation, the outcome of early surgery was better than conservative management. Although the characteristics of the conservative management group was more favorable, complication rate seemed to be high.

Non-obstetric surgery during pregnancy – an eleven-year retrospective analysis

“…These findings are in line with our results showing that surgical intervention had no influence on pregnancy outcome. Barut et al and others have concluded that although conservative management of acute cholecystitis was favored, early surgical intervention showed better results [7]. Cholecystectomy was performed in our study in 4 cases (5%), without adverse effects on pregnancy.…”

“…The most frequent indications for surgery during pregnancy are infections such as acute appendicitis and cholecystitis [5][6][7][8][9][10][11][12][13][14]; pregnant women may also require acute surgical intervention for ovarian disorders and bowel obstruction, as well as for traumatological or oncological indications [11]. Any kind of pathology can occur in pregnant women and require immediate surgical treatment and optimized interdisciplinary management to achieve maximum safety for both mother and fetus, to avoid teratogenous medication, fetal acidosis and hypoxemia, and adverse pregnancy outcomes such as miscarriage, stillbirth or premature birth [4,8].…”

γ-glutamyl transferase-to-platelet ratio based nomogram predicting overall survival of gallbladder carcinoma

“…Study on surgical resection for GBC has revealed GGT’s diagnostic value[ 16 ]. Clinically, GGT has been administered in the evaluation of gallbladder diseases such as cholangiocarcinoma[ 17 ], biliary atresia[ 18 ], and cholecystitis[ 19 ]. Emerging evidence also indicates that higher GGT levels may be linked to a high cancer risk.…”

Acute cholecystitis in pregnancy: a case report

“…1 3.5-10% of all pregnant women have USG detectable cholelithiasis, however, only 0.05-0.3% will develop cholecystitis. [2][3][4] Common symptoms of acute cholecystitis include severe pain in the RUQ or epigastrium, which can radiate to the right shoulder or back, and there is often fever, nausea, vomiting and anorexia. As these symptoms are not very specific and the pain localization is often unclear, cholecystitis can be difficult to recognize in pregnant women, and there are many differential diagnoses to be considered, including acute pyelonephritis, fatty liver disease and intrahepatic cholestasis of pregnancy, which were the first suspected diagnoses in our case.…”

“…5,6 If such symptoms are present, the best diagnostic method for differentiation is abdominal USG, which is very reliable with an accuracy of 95-98% in detecting gallstones, however, it can be technically challenging and requires a professional, therefore in this case the patient was sent to a multidisciplinary hospital where such professionals were available. 4,7 ERCP is also a common diagnostic method of choice as it provides therapy options as well, however, in this case MRI was chosen to evaluate the dynamics of the condition. 4,8 According to many studies and guidelines, laparoscopic cholecystectomy is the method of choice in the management of acute cholecystitis in pregnant patients.…”