Cholecystitis in pregnancy

Unique presentation of perforated gallbladder and gangrene in third trimester pregnancy: management and other considerations

Acute cholecystitis during pregnancy presents significant risks, requiring careful management to balance maternal and fetal health. Conflicting viewpoints exist on conservative versus surgical treatment, particularly in the third trimester. Here, we present a case of a woman in her early 40s at 34 weeks of gestational age with acute cholecystitis and signs of preterm labour. Despite conservative management, she developed sepsis, necessitating a subtotal cholecystectomy due to gallbladder perforation and chronic inflammation. Postoperatively, a cystic duct bile leak was managed with endoscopic retrograde cholangiopancreatography. She was discharged on postoperative day 4 and later had an uncomplicated term vaginal delivery. This case underscores the importance of individualised treatment plans and supports the safety of laparoscopic cholecystectomy during the third trimester. Enhanced research and multidisciplinary provider education are crucial for improving patient decision-making regarding surgical intervention during pregnancy.

The global prevalence of gallstones in pregnancy: A systematic review and meta-analysis

Background

Gallstone disease is the second most common non-gynecological disease that may require surgical intervention during pregnancy. This study investigates the global prevalence of gallstones in pregnancy through a systematic review and meta-analysis.

Methods

A systematic review and meta-analysis of studies that reported the global prevalence of gallstones in pregnancy was conducted. PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar were searched for studies published up to September 2022.

Results

In a review of 31 studies with a sample size of 190,714 people, the I2 heterogeneity test showed high heterogeneity (I2 = 98.8%). Therefore, the random effects method was used to analyze the results. The prevalence of gallstones was reported as 3.6% (95% CI: 1.9-6.7%). The highest prevalence of gallstones by continent was reported in America, at 6.8% (95% CI: 4.2-10.8%). The Egger test showed no evidence of publication bias (p = 0.609).

Conclusion

Based on the results of this study, health policymakers should emphasize to the target community and the medical staff dealing with pregnant women the importance of screening for gallstones during pregnancy.

Gallbladder diseases in pregnancy: Sonographic findings in an indigenous African population

Aim of the study

This study aimed to evaluate the prevalence of gallbladder disease in gravid Nigerian women and to elucidate any association with gravidity and ABO blood group.

Materials and Methods

This was a descriptive cross-sectional study of six hundred and fifty-six (656) pregnant women recruited from March 2015 to March 2016. Hemoglobin genotype and blood group were recorded and a sonographic examination was performed using Siemens ultrasound scanner. Statistical analysis was done using STATA software for Windows.

Results

Age had a significant association with the occurrence of gallbladder diseases (Likelihood ratio = 7.116, P = 0.03). Two (0.3%) pregnant women had biliary sludge, 11 (1.7%) had gallstones while 643 (98%) had normal gallbladders. Also, only one (9.1%) primigravida woman with gallstone was found in this study while 10 (90.9%) of the women with gallstones were multigravida. All the pregnant women who had gallstone(s) had blood group O. Of the two women with biliary sludge; one had blood group A while the other had blood group O.

Conclusions

The incidence of gallbladder disease increased with age in this study. There was a higher prevalence of gallstones than sludge in pregnancy. Also, the incidence of gallstones increased with the number of pregnancies among the women with gallstones. Attention should be paid to the gallbladder during abdominal sonography in pregnancy.

Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations

OBJECTIVE

The objectives of this article are to discuss the current evidence-based recommendations regarding the use of diagnostic imaging in the evaluation of pulmonary embolism, appendicitis, urolithiasis, and cholelithiasis during pregnancy.

CONCLUSION

Diagnostic imaging should be performed during pregnancy only with an understanding of the maternal and fetal risks and benefits, the comparative advantages of different modalities, and the unique anatomic and physiologic issues associated with pregnancy.