Treatment of pregnant patients with calcular cholecystitis, choledocholithiasis, and obstructive jaundice

The article is devoted to the treatment of patients with various manifestations of cholelithiasis during pregnancy to clarify tactical approaches to the treatment of pregnant women with choledocholithiasis. The patients were treated simultaneously by a surgeon and an obstetrician-gynecologist. The article discusses the treatment of 22 patients with cholelithiasis - 20 with acute calculous cholecystitis and 2 with choledocholithiasis. 5 patients from 20 (25%) were operated on for stool cholecystitis. The rest received conservative treatment One patient with choledocholithiasis was treated conservatively, and the second patient underwent transpapillary intervention. There were no fetal complications in any of the 22 patients. It is concluded, that reasonable minimalism should be adhered to in the treatment of pregnant women admitted urgently to the hospital with various manifestations of cholelithiasis, as well as the safety and necessity of using endoscopic methods for the diagnosis and treatment of choledocholithiasis in pregnant patients.

1. Vakhrushev J.M., Khokhlacheva N.A. GALLSTONE DISEASE: EPIDEMIOLOGY, RISK FACTORS, CLINICAL FEATURES, PREVENTION. The Russian Archives of Internal Medicine. 2016;6(3):30-35. (In Russ.) https://doi.org/10.20514/2226-6704-2016-6-3-30-35

2. Uspenskaya Yu.B., Sheptulin A.A. Features of pathogenesis, diagnostics and treatment of gallstone disease at pregnancy. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(2):111-116. (In Russ.) https://doi.org/10.22416/1382-4376-2017-27-2-111-116

3. Kitaeva M.A., Korolkov A.Yu., Bezhenar V.F., Smirnov D.A., Popov D.N., Bagnenko S.F. SURGICAL TACTICS IN COMPLICATIONS OF GALLSTONE DISEASE IN PREGNANT WOMAN AT LATE STAGES OF GESTATION. Grekov's Bulletin of Surgery. 2018;177(3):45-48. (In Russ.) https://doi.org/10.24884/0042-4625-2018-177-3-45-48

4. Athwal R., Bhogal R.H., Hodson J., Ramcharan S. Surgery for gallstone diseasе during pregnancy does not increase fetal or maternal mortality: a meta-analysis. Hepatobiliary Surg Nutr. 2016;5(1):53-7. https://doi.org/10.3978/j.issn.2304-3881.2015.11.02

5. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65:146-81.

6. Sedaghat N., Cao A.M., Eslick G.D., Cox M.R. Laparoscopic versus open chоlecystectomy in pregnancy: a systematic review and metaanalysis. Surg.Endosc. 2016;20. https://doi.org/10.1007/s00464-016-5019-2

7. Rinchinov V.B., Plekhanov A.N. Otsenka effektivnosti endoskopicheskoy partsi-al'noy papillosfinkterotomii s ballonnoy dilatatsiey pri krupnom kholedokholitiaze. Vestnik Buryatskogo gosudarstvennogo universiteta. 2017;1:62–66. (In Russ.)

8. Romashchenko PN, Fekliunin AA, Maistrenko NA, Filin AA, Omran VS, Zherebtsov ES. Trans-papillary endoscopic surgery: predictors of complications and prevention of their development. Endoscopic Surgery. 2021;27(1):40-48. (In Russ.) https://doi.org/10.17116/endoskop20212701140

9. Takeshi Ogura, Kazuhide Higuchi. A review of treatment options for bile duct stones. Expert Rev Gasroenterol Hepatol. 2016;10(11):1271-1278. https://doi.org/10.1080/17474124.2016.1212658

10. Skupchenko SS, Koryttsev VK, Krasnoslobodtsev AM. Management of a patient with mechanical jaundice and chronic pancreatitis during pregnancy. Endoscopic Surgery. 2024;30(4):61-64. (In Russ.) https://doi.org/10.17116/endoskop20243004161