The role of common bile duct exploration with biliary drainage in choledocholithiasis during pregnancy
Article Sidebar
November 30, 2021
August 4, 2022
February 10, 2023
Abstract
Pregnancy is a risk factor for gallstone disease and may evolve into symptomatic choledocholithiasis/ common bile duct (CBD) stone; however, the treatment of choice is controversial and may not apply to all gestational ages. Standard therapy with endoscopic retrograde cholangiopancreatography (ERCP) exposes the patient and fetus to ionizing radiation; hence other strategies are needed to address this problem. We report a case of 29 years old female presented with biliary pain and jaundice. The patient was pregnant at 14 weeks gestation age. Laboratory data showed biliary obstruction, and abdominal ultrasound showed multiple bile duct stones with significant dilatation in the CBD. CBD exploration with external biliary drainage was performed to treat obstructive jaundice while avoiding ionizing radiation exposure to the fetus and patient. After the procedure, the patient showed clinical improvement. CBD exploration with external biliary drainage avoids ionizing radiation in choledocholithiasis management. This method may be applied as a temporary emergent treatment of obstructive jaundice in pregnant patients with gestational age sensitive to ionizing radiation.
References
Azab, M., Bharadwaj, S., Jayaraj, M., Hong, A., Solaimani, P., Mubder, M., Volk, M. (2019). Safety of endoscopic retrograde cholangiopancreatography (ERCP) in pregnancy: A systematic review and metaâ€analysis. Saudi Journal of Gastroenterology, 25(6), 341-54.
Beckingham, I. J. (2020). Gallstones. Hepatobiliary Surgery, 38(8), 453-62.
Chamberlain, S. L., & Croagh, D. (2020, Mar). Managing choledocholithiasis in pregnancy: a novel approach. BMJ Case Rep, 13(3).
Chan, C., & Enns, R. (2012). ERCP in the management of choledocholithiasis in pregnancy. Current Gastroenterology Reports, 14, 504-10.
Everson, G. T. (1993). Pregnancy and gallstones. Hepatology, 17(1), 159-61.
Everson, G. T., McKinley, C., & Fern, F. (1991, Jan). Mechanisms of gallstone formation in women: effects of exogenous estrogen (premarin) and dietary cholesterol on hepatic lipid metabolism. The Journal of Clinical Investigation, 87(1), 237-46.
Gurusamy, K. S., Koti, R., & Davidson, B. R. (2013). T-tube drainage versus primary closure after open common bile duct exploration. Cochrane Database Syst Rev(6).
Jackson, H., Granger, S., Price, R., Rollins, M., Earle, D., Richardson, W., & Fanelli, R. (2008). Diagnosis and laparoscopic treatment of surgical diseases during pregnancy: an evidence-based review. Surgical Endoscopy, 22, 1917-27.
Kalaleh, M., Hartwell, G. D., Arseneau, K. O., Pajewski, T. N., Mullick, T., Isin, G., Yeaton, P. (2014). Safety and efficacy of ERCP in pregnancy. Gastrointestinal Endoscopy, 60(2), 287-92.
Kern, F., Everson, G. T., DeMark, B., McKinley, C., & et al. (1981, Nov). Biliary lipids, bile acids, and gallbladder function in the human female : Effects of pregnancy and the ovulatory cycle. The Journal of Clinical Investigation, 68(5), 1229-42.
Lu, E. J., Cure, M. J., El-Sayed, Y. Y., & Kirkwood, K. S. (2004). Medical versus surgical management of biliary tract disease in pregnancy. The American Journal of Surgery, 188, 755-9.
Otheman, M. O., Stone, E., Hashimi, M., & Parasher, G. (2012). Conservative management of cholelithiasis and its complications in pregnancy is associated with recurrent symptoms and more emergency department visits. Gastrointestinal Endoscopy, 76(3), 564-9.
Parangi, S., Levine, D., Henry, A., Isakovich, N., & Pories, S. (2007, Jul). Surgical gastrointestinal disorders during pregnancy. The American Journal of Surgery, 193, 223-32.
Shaffer, E. A., Taylor, P. J., Logan, K., Gadomski, S., & Corenblum, B. (1984, Mar). The effect of a progestin on gallbladder function in young women. American Journal of Obstetrics & Gynecology, 148(5), 504-7.
Stinton, L. M., & Shaffer, E. A. (2012, Apr). Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut and Liver, 6(2), 172-87.
Tham, T. C., Vandervoort, J., Wong, R. C., Montes, H., Roston, A., Slivka, A., Carr-Locke, D. (2003). Safety of ERCP during pregnancy. The American Journal of Gastroenterology, 98(2), 308-11.
Valdivieso, V., Covarrubias, C., Siegel, F., & Cruz, F. (1993). Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. Hepatology, 17(1).
Williams, P. M., & Fletcher, S. (2010). Health effects of prenatal radiation exposure. American Family Physician, 82(5), 488-93.
Authors
Qanun Medika by FK UM Surabaya is liscence under Lisensi Creative Commons Atribusi 4.0 Internasional.
