Surgical Management of Underlying Biliary Disease in Refractory Hyperemesis Gravidarum

Abstract

Hyperemesis gravidarum (HEG) is the most common cause of hospitalization during the first half of pregnancy. It affects approximately 0.3-3% of all pregnancies [1]. There is no one accepted definition or diagnostic criteria for HEG. The most commonly cited criteria include persistent vomiting not related to other causes, measure of acute starvation (most commonly ketonuria), and weight loss; most often loss of at least 5% of pre-pregnancy body weight [2]. Symptoms typically begin in the late first trimester and are rarely associated with abdominal pain. HEG is managed a stepwise fashion by adding pharmacotherapy sequentially until symptom resolution [3, 4]. Patients who present with classic signs and symptoms of HEG but are non-responsive to all levels of therapy present a therapeutic challenge. In these cases, the search for other causes of nausea and vomiting should be undertaken. In the current report, we review 10 cases of refractory HEG. Eight patients were incidentally diagnosed with biliary disease by abdominal ultrasound (US) during workup for refractory symptoms. These patients underwent surgical consultation and were subsequently offered laparoscopic cholecystectomy. Here, we review the pregnancy courses from initial presentation until delivery to explore the incidence of underlying biliary disease and role of cholecystectomy in refractory HEG.