Management of impacted common bile duct stones in late stage pregnancy and immediately post-partum after failed endoscopic stone extraction

Abstract

Introduction: Symptomatic gallstone disease is the second most common abdominal emergency in pregnant women after acute appendicitis. Extrahepatic biliary obstruction by gallstones during pregnancy remains one of the most challenging management problems in the field of surgery. Although there have been many advancements in the surgical and endoscopic management of gallstone disease, the risks of these interventions and anesthesia to the developing fetus still prevents their routine application during the gestational period. Traditionally, these types of disorders during pregnancy are managed conservatively or via appropriately timed cholecystectomy. However, when the late­term pregnant patient presents acutely with evidence of biliary tract obstruction and sepsis, it represents a medical or surgical emergency. Case report: We present the case management of a 25­year­old late term pregnant female with an impacted www.ijcasereportsandimages.com common bile duct stone and impending biliary sepsis as a result of failed postpartum endoscopic stone extraction. Conclusion: Due to the risk of potential harm to the fetus, this patient subset must be managed in clinically sound and technically proficient manner, which does not allow time for conservative management. Consequently, appropriate management algorithms for conservative therapy versus endoscopic or surgical interventions need to be clearly outlined and defined.