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Biliary Tract Emergencies
https://t.me/medicina_free
16
Abstract
The most common causes of gallbladder dis­ease in pregnancy are gallstones and biliary sludge. In pregnancy, the incidence of gall­bladder disease is 0.05–0.3%, and asymptom­atic gallstones occur in 3.5–10% of all pregnancies. Acute cholecystitis during preg­nancy is one of the most common nonobstetric operative conditions, and 40% of pregnant patients with symptomatic cholelithiasis require cholecystectomy during pregnancy. Natural history and clinical examination are similar to those in the nonpregnant population. Therapeutic options are medical, open surgi­cal, and laparoscopic procedures. Laparoscopy is increasingly used. In the advanced third tri­mester, conservative treatment is recom­mended until delivery. 1/1200 pregnancies are complicated by common bile duct stones. Common bile duct stones have been observed in 10–12.5% of pregnant women undergoing cholecystectomy and account for 7% of cases
of jaundice in pregnancy. Diagnostic workup and therapeutic management are complex and depend on the maternal status, severity of the disease, infection, duration of pregnancy, and status of the fetus. Choledochal cysts are extremely rare but rupture more frequently than in nonpregnant populations.
16.1 Acute Cholecystitis/Biliary
Colic
16.1.1 Historical Perspective
Friedrich Daniel von Recklinghausen (1833–
1910) found that 90% of women with gallstones
have been gravid at least once. Subsequent nd­ings by Ludwig Georg Courvoisier (1843–1918) in autopsy studies revealed that three times as many women have gallstones as men, pointing at pregnancy as one of the major risk factors for cholelithiasis [1].
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 G. Augustin, Acute Abdomen During Pregnancy, https://doi.org/10.1007/978-3-031-26021-6_16
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