Management of complicated gallstone disease during pregnancy.
BACKGROUND
Controversy still exists regarding the optimal management of complicated gallstones during pregnancy owing to the possible risks for the fetus. Generally the management of such problems during pregnancy is conservative, however, endoscopic retrograde cholangiopancreatography (ERCP) and/or operative intervention may be required in some patients.


OBJECTIVE
The aim is to evaluate the management of complicated gallstone disease with particular reference to the indications, timing and risks of ERCP and operative intervention during pregnancy and its effect on fetus outcome.


METHODS
This retrospective study was conducted on 32 pregnant women, who were admitted with complication of cholelithiasis at Riyadh Medical Complex (RMC) through the emergency during the period of March 1998-October 2002. Their files were evaluated for age, presentation, gestational age, hematological, radiological, fetus assessment, management, fetus out come and how ERCP and surgery were performed.


RESULTS
Among the 32 pregnant women studied, 22 responded satisfactorily to conservative treatment. They had laparoscopic cholecystectomy (LC) after delivery. Ten patients needed further treatment, two were operated for acute cholecystitis (AC) and recurrent biliary colic (BC). Eight patients had ERCP for obstructive jaundice and recurrent pancreatitis following which two had LC cholecystectomy. All patients remained well until delivery.


CONCLUSIONS
Majority of gallstone complications during pregnancy can be managed conservatively. Surgery can be deferred until delivery. Few patients who needed ERCP and/or surgery can be managed safely during second and third trimester.
Department of Surgery, Riyadh Medical Complex, Riyadh, Saudi Arabia.
Mohammed Hamad
MH
Al-Akeely