Percutaneous cholecystostomy treatment of acute cholecystitis in pregnancy

Abstract

Medical treatment of acute cholecystitis in pregnancy may lead to prolonged management and recurrent hospitalizations, whereas surgical management predisposes the mother and fetus to the inherent risks of surgery and general anesthesia. Although percutaneous cholecystostomy has been proven to be an efficacious treatment in critically ill and general surgery patients who are at high risk for surgery, this technique has not been used routinely as a treatment for acute cholecystitis in pregnancy. We report two women (at 30 and 32 weeks' gestation, respectively) who presented with acute calculus cholecystitis. The first patient was a 33-year-old female who failed endoscopic retrograde cholangiopancreatography and papillotomy and had multiple return visits for nausea and vomiting. The second patient was a 23-year-old female with three previous admissions for cholecystitis during the pregnancy. These two patients underwent emergency ultrasound-guided percutaneous transhepatic cholecystostomy. Percutaneous cholecystostomy provided adequate biliary decompression for the remainder of the pregnancy; the patients delivered healthy infants and underwent successful uncomplicated elective laparoscopic cholecystectomy within 3 months of delivery. Percutaneous cholecystostomy may provide a safe and effective alternative for the palliation of acute cholecystitis in pregnancy until a postpartum cholecystectomy can be performed.