Report of a Case of Difficult Cholecystectomy in a 34th Gestational age of Pregnancy

Document Type : Case Report

Authors

1 General and Pediatric Surgery Specialist, Mehrad Hospital

2 General Surgery Specialist, Mehrad Hospital

3 General Physician, Research Assistant, Mehrad Hospital

Abstract
Treatment of acute abdomen including acute cholecystitis in pregnant women has been controversial. Although recent advances had resulted in increasing use of laparoscopic procedures in these patients, however, based on anatomical and physiological changes in pregnancy, many surgeons are concern with laparoscopic cholecystectomy (LC) in high gestational age. In current manuscript, we report a 25 years old pregnant female with acute cholecystitis and pancreatitis at 34 weeks of gestational age underwent medical treatment for pancreatitis followed by LC. The general status of the mother and infant are satisfying after 3 years follow up.

Keywords


1. Coleman MT, Trianfo VA, Rund DA. Nonobstetric emergencies in pregnancy: trauma and surgical conditions. Am J Obstet Gynecol 1997; 177: 497-502.
2. Mazze RI, Kallen B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989; l6l: 1178-1185.
3. Cheek TG, Baird E. Anesthesia for nonobstetric surgery: maternal and fetal considerations. Clin Obstet Gynecol 2009; 52: 535-45.
4. Gilo NB, Amini D, Landy HJ. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol 2009; 52: 586-96.
5. Bouyou J, Gaujoux S, Marcellin L, Leconte M, Goffinet F, Chapron C, Dousset B. Abdominal emergencies during pregnancy. J Visc Surg 2015; 152 (6 Suppl): S105-15.
6. Thomas SJ, Brisson P. Laparoscopic appendectomy and cholecystectomy during pregnancy: six case reports. JSLS 1998; 2(1): 41-6.
7. Tseng JY, Yang MJ, Yang CC, Chao KC, Li HY. Acute cholecystitis during pregnancy: What is the Best Approach? Taiwan J Obstet Gynecol 2009; 48(3): 305-7.
8. Juhasz-Böss I, Solomayer E, Strik M, Raspé C. Abdominal surgery in pregnancy-an interdisciplinary challenge. Dtsch Arztebl Int 2014; 111(27-28): 465-72.
9. Nasioudis D, Tsilimigras D, Economopoulos KP. Laparoscopic cholecystectomy during pregnancy: A systematic review of 590 patients. Int J Surg 2016; 27: 165-75.
10.    Buser KB. Laparoscopic surgery in the pregnant patient-one surgeon's experience in a small rural hospital. JSLS 2002; 6(2): 121-4.
11.    Rangarajan M, Palanivelu C, Madankumar MV, Senthilkumar R. Emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy. J Coll Physicians Surg Pak 2008; 18(12): 781-3.
12.    Pezzolla A, Lattarulo S, Disabato M, Barile GPrimiceri G, Paradies D. Laparoscopic cholecystectomy for acute cholecystitis in pregnancy: a case report in woman with situs viscerum inversus. Recenti Prog Med 2012; 103(12): 578-80.
14.    Paramanathan A, Walsh SZ, Zhou J, Chan S. Laparoscopic cholecystectomy in pregnancy: An Australian retrospective cohort study. Int J Surg 2015; 18: 220-3.
15.    Cox TC, Huntington CR, Blair LJ, Prasad TLincourt AE, Augenstein VA, et al. Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients. Surg Endosc 2016; 30(2): 593-602.
16.    Azuar AS, Bouillet-Dejou L, Jardon K, Lenglet Y, Canis M, Bolandard F, et al. Laparoscopy during pregnancy: experience of the French university hospital of Clermont-Ferrand. Gynecol Obstet Fertil 2009; 37(7-8): 598-603.
17.    Weiner E, Mizrachi Y, Keidar RKerner R, Golan A, Sagiv R. Laparoscopic surgery performed in advanced pregnancy compared to early pregnancy. Arch Gynecol Obstet 2015; 292(5): 1063-8.
18.    Meshikhes AN. Successful laparoscopic cholecystectomy in the third trimester of pregnancy. Saudi Med J 2008; 29(2): 291-2.
19.    Machado NO, Machado LS. Laparoscopic cholecystectomy in the third trimester of pregnancy: report of 3 cases. Surg Laparosc Endosc Percutan Tech 2009; 19(6): 439-41.
20.    Geisler JP, Rose SL, Mernitz CS, Warner JL, Hiett AK. Non-gynecologic laparoscopy in second and third trimester pregnancy: obstetric implications. JSLS 1998; 2(3): 235-8.
21.    Bennion LJ, Grundy SM. Risk factors for the development of cholelithiasis in man. N Engl J Med. 1978; 29: 1221-1227.
22.    Samuels P, Landon MB. Hepatic Disease. In Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal & Problem Pregnancy, 3rd ed. New York: Churchill Livingstone; 1997: 1119-1134.
23.    Jorge AM, Keswani RN, Veerappan A, Soper NJ, Gawron AJ. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg 2015; 19(4): 598-603.
24.    Dixon NP, Faddis DM, Silberman H. Aggressive management of cholelithiasis during pregnancy. Am J Surg 1987; 154: 292-294.
26.    Brooks DC, Sznyter LA. Approach to abdominal pain in pregnant patients. Sci Am Surg [serial online]. 2000; section VII: chapter 11. Available at: http:// webmd-practice.webmd.com/sas.
27.    Printen KJ, Ott RA. Cholecystectomy during pregnancy. Am Surg 1978; 44: 432-434.
28.    Laparoscopic    surgery    in    pregnancy.    Updated March 14, 2016. http://www.uptodate.com/contents/laparoscopic-surgery-in-pregnancy? Source=search-result & search = Laparoscopic+surgery+in+pregnancy & selected title = 1 ~ 150.
29.    Ahmadi Amoli H, Tavakoli H, Yaghoubi Notash A, Sajad Far M, Khashayar P. Laparoscopic

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
cholecystectomy during pregnancy: A case series. J Minim Access Surg 2008; 4(1): 9-14.
30.    Kim YW, Zagorski SM, Chung MH. Laparoscopic common bile duct exploration in pregnancy with acute gallstone pancreatitis. JSLS 2006; 10: 78-82.