title: [Choledocholithiasis and pregnancy. Hybrid laparo-endoscopic treatment in one step].
abstract: BACKGROUND
  Complications associated with choledocholithiasis are uncommon during pregnancy. However, when it occurs, the morbidity and mortality related for the product and the mother increases, so a proper treatment is imperative in these patients.
  
  
  METHODS
  A 25-year-old pregnant woman on her second trimester. The current condition was started four days prior to the hospital admission with abdominal pain in the right upper quadrant with nausea and vomit.Twenty-four hours later jaundice and dark urine is observed. Physical examination shows scleral jaundice, right upper quadrant abdominal pain without peritoneal irritation. Uterus at umbilicus level without uterine activity. Uterus at umbilicus level without uterine activity. Laboratory tests showed elevated bilirubin and transaminases without leukocytosis; ultrasound reported live intrauterine unique product, with a heart rate of 128 beats per minute, gallbladder with multiple images inside that cast acoustic shadowing, and a 10 mm common bile duct dilated bile duct with dilatation of intrahepatic bile ducts. It was perform laparoscopic cholecystectomy with intraoperative cholangiography and placement of a transcystic jaguar guide for selective cannulation of the common bile duct. Intraoperative endoscopic retrograde cholangiopancreatography was performed with endoscopic stone extraction. The outcome was satisfactory with a hospital discharge at 48 hours.
  
  
  CONCLUSIONS
  Current evidence has shown that the combined use of laparoscopy and therapeutic endoscopic cholangiography in one step is effective for the treatment of choledocholithiasis, decreasing the risk of complications associated with cannulation of the bile duct.
authors.affiliation: Servicio de Cirugía de Invasión Mínima y Cirugía Bariátrica, Hospital Regional de Alta Especialidad, Zumpango, Estado de México, Mexico. david.valadez@cirugia-laparoscopica.com.
authors.forename: David
authors.initials: D
authors.lastname: Valadez-Caballero
authors.affiliation: Servicio de Cirugía de Invasión Mínima y Cirugía Bariátrica, Hospital Regional de Alta Especialidad, Zumpango, Estado de México, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: González-Santamaría
authors.affiliation: Servicio de Cirugía de Invasión Mínima y Cirugía Bariátrica, Hospital Regional de Alta Especialidad, Zumpango, Estado de México, Mexico.
authors.forename: Héctor
authors.initials: H
authors.lastname: Soto-Mendoza
authors.affiliation: Servicio de Cirugía de Invasión Mínima y Cirugía Bariátrica, Hospital Regional de Alta Especialidad, Zumpango, Estado de México, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Alberto Blanco-Figueroa
authors.affiliation: Servicio de Cirugía de Invasión Mínima y Cirugía Bariátrica, Hospital Regional de Alta Especialidad, Zumpango, Estado de México, Mexico.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Flores-Pantoja
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy / Q000379:methods*; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D016216:Ultrasonography, Prenatal
keywords: Choledocholithiasis; cirugía laparo-endoscópica; colangiografía retrógrada endoscópica; coledocolitiasis; embarazo; endoscopic retrograde cholangiopancreatography; laparo-endoscopic surgery; pregnancy