Research Day
UTILIZING PERCUTANEOUS CHOLECYSTOSTOMY TUBE AS A TEMPORARY APPROACH FOR ACUTE CHOLECYSTITIS DURING 3RD TRIMESTER OF A HIGH-RISK PREGNANCY
Document Type
Abstract
Date
2021
Abstract
Background: Cholecystitis is the second most common non-obstetric surgical cause of acute abdomen during pregnancy. Laparoscopic cholecystectomy (LC) has become the treatment modality for cholecystitis during pregnancy. However, in high-risk patients, such as late, and twins pregnancy, laparoscopic or open cholecystectomy could be challenging. Utilizing percutaneous cholecystostomy tube (PCCT) offers a temporary management option in peripartum period until interval LC is performed.
Case Description: We present a high-risk pregnancy case of a 41-year-old woman at 34th week of gestation with a dichorionic-diamniotic-twin gestation, with a known history of choledocholithiasis. She presented with back pain and a positive sonographic Murphy sign, with ultrasound findings suggesting an early acute cholecystitis. Due to pregnancy status, and weighing risks/benefits of surgery, a PCCT for gallbladder decompression was chosen. An interval LC was performed, safely, 4 weeks later (i.e. postpartum day 4 after Caesarean Section).
Discussion: Laparoscopy has become the preferred treatment modality for many surgical diseases during pregnancy at all trimesters. LC has been shown to be a safe procedure. However, a recent study from a large national data base in the USA found that 3rd trimester cholecystectomies were associated with increased hospital stay, preterm delivery, and readmission. Although rarely used as a first-line intervention for gallbladder diseases, PCCT is an important minimally invasive procedure for treatment of cholecystitis in patients who are high-risk to undergo surgery due to concurrent comorbid condition. Our case is unique due to the twin gestation, advanced maternal age, and gestational age.