Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Acute cholecystitis in pregnant women: A therapeutic challenge in a developing country center

  • Mohamed Fares Mahjoubi (Department of Surgery A, Charles Nicolle Hospital) ;
  • Anis Ben Dhaou (Department of Surgery A, Charles Nicolle Hospital) ;
  • Mohamed Maatouk (Department of Surgery A, Charles Nicolle Hospital) ;
  • Nada Essid (Department of Surgery A, Charles Nicolle Hospital) ;
  • Bochra Rezgui (Department of Surgery A, Charles Nicolle Hospital) ;
  • Yasser Karoui (Department of Surgery A, Charles Nicolle Hospital) ;
  • Mounir Ben Moussa (Department of Surgery A, Charles Nicolle Hospital)
  • Received : 2023.03.08
  • Accepted : 2023.06.24
  • Published : 2023.11.30
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Abstract

Backgrounds/Aims: Acute cholecystitis is a rare condition in pregnant women, potentially affecting the maternal and fetal prognosis. Our aim was to report the main clinical and paraclinical features of acute cholecystitis during pregnancy and therapeutic modalities. Methods: We conducted a case series analysis recording pregnant patients with acute cholecystitis admitted to our surgery department over a period of 11 years. We collected clinical data, paraclinical features, and management modalities related to cholecystitis. Results: There were 47 patients. Twenty-eight percent was in the first trimester of pregnancy, 40% in the second, and 32% in the third trimester. Abdominal pain was located in the right hypochondrium in 75% of cases. Fever was noted in 21% of cases. C-reactive protein was elevated in 39% of patients. Cholestasis markers were high in four patients. Abdominal ultrasound showed a distended gallbladder in 39 patients, with thickened wall in 34 patients, and gallbladder lithiasis in all cases. No patient had a dilated main bile duct. All patients received intravenous antibiotic therapy. Tocolysis was indicated in 32 patients. Laparoscopic cholecystectomy was performed in 32 cases (68%), and open cholecystectomy in 15 cases (32%). Postoperative course was uneventful in 42 patients, and complicated in 5 patients. Rate of complications was statistically higher after open cholecystectomy (p = 0.003). Morbidity rate was higher in the third trimester (p = 0.003). Conclusions: Delay in the diagnosis of acute cholecystitis during pregnancy can lead to serious complications. Management is based on antibiotic therapy and cholecystectomy. Laparoscopic cholecystectomy appears to be less morbid than open cholecystectomy.

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References

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