This is a 29-year-old woman, five weeks pregnant, who was referred for five days of nausea, vomiting and pain in the upper hemiabdomen.
On examination the patient had a positive murphy.
Laboratory tests showed leukocytosis of 15 x 109/L, amylasemia of 1,300 IU/L, AST of 78 IU/L, ALT of 272 IU/L. She had multiple gallstones of 2GT88 IU/L.
No clear signs of malignancy were observed.
The clinical status deteriorated and despite being in the first trimester, it was decided to perform a surgical intervention performing LC with an intra-abdominal pressure lower than 12 mmHg in a time of 55 minutes.
An intraoperative cholangiography was normal.
The postoperative period was 5 days and the pregnancy was uneventful.
During pregnancy, as well as patients taking oral contraceptives or during the menopausal period, the incidence of meningitis is increased by estrogen stimulation (2).
Pregnant women do not suffer from an episode of mental illness but rather from psychiatric disorders.
CL during pregnancy is not associated with risks to the patient and fetus despite its great acceptance.
Thus, the use of carbon dioxide to perform pneumoperitoneum can cause respiratory acidosis in the mother and fetus, and the use of nitrous oxide has been proposed (3).
Nevertheless, the short-term effects of severe foetal acidosis in animals have not shown any adverse effects (4).
In addition, increased intra-abdominal pressure and uterine pressure on the inferior vena cava can decrease venous return flow and consequently decrease cardiac output, uterine irrigation and fetal hypoxia.
Some authors use minimal intra-abdominal pressures and a left lateral decubitus position with a minimum anti-Trendelenberg position (4).
Some studies show that one can work with minimum air pressures, but the risk of conversion is higher (5).
It is recommended that an epigastric tube be placed first (6).
Intraoperative cholangiography is not routinely recommended and is only recommended for patients with risk factors for developing cholelithiasis (history of pancreatitis, jaundice or dilatation).
There is an increased risk of obstetric complications such as miscarriage in the first trimester (7).
CL in pregnant women should be postponed to the second trimester (4).
There is extensive experience in LC and it has been demonstrated a lower rate of complications in the mother and fetus in the group of operated patients compared to the group of pregnant women with conservative management of biliary pathology (8).
LC offers advantages over open cholecystectomy and should be considered as the first choice during pregnancy (9).
It requires surgical experience to achieve a shorter time and must be accompanied by a series of measures aimed at reducing possible maternal and fetal complications (10).
1.
R. Vilallonga, J. J. Pathogenesis, C. Margarit and J. Balsells
Hepatobiliary-pancreatic Surgery and Hepatic Transplant Unit.
Department of General Surgery and Gastroenterology.
Hospital Vall d ́Hebron.
Autonomous University of Barcelona
