After the ERCP, a new EUS is performed to confirm that the common bile duct does not have lithiasis inside thus, the pancreatic duct is not cannulated.Ī 37-year-old patient with a 31-week pregnancy, with no significant history, presents a clinical picture of approximately 2 months of evolution characterized by episodes of abdominal pain located in the right hypochondrium. Finally, a new sweep is performed to extract bile without any other calculi. A wide papillotomy was performed without complications, and, later, a papillotome was exchanged by an extractor balloon. Subsequently, the hydrophilic guide is removed and then suctioned with the syringe until non-purulent bile fluid is obtained, confirming that the papillotome is in the bile duct ( Figure 3). The papilla is then cannulated by directing the tip of the papillotome to the 11 o’clock meridian with an easy and deep advance of the guide about 5 cm. Taken from: Tokyo Guidelines 2018.Īn ERCP is performed the short-axis papilla is confronted with the arched papillotome and the hydrophilic guide, which shows the scant outflow of bile through the ampullary orifice. Elevation more than 1.5 times the normal upper limitĬ-1 Dilation of the bile duct C-2 Evidence of etiology on imaging (stenosis, calculus, stent, etc.)ĭiagnostic suspicion: an item A + an item B or Cĭefinitive diagnosis: one item in A + one item in B + one item in CĪP: alkaline phosphatase GGT: gamma-glutamyl transferase. Finally, the radial EUS is removed, and a duodenoscope is inserted.Ī-1 Fever (> 38 ☌) or chills A-2 Inflammatory response in laboratories (leukocytes or = 1 mg/dL)ī-1 Jaundice (total bilirubin > or = 2 mg/dL) B-2 Altered liver function tests (AP, GGT, AST, and ALT). In this sense, the result of the study is compatible with choledocholithiasis and cholelithiasis ( Figure 2). EUS is performed, which reveals the second portion of the duodenum with the usual appearance and the common bile duct of 6 mm diameter in the middle portion, a hyperechoic image that projects a posterior acoustic shadow compatible with a calculus of 5 mm x 9 mm in diameter, and a distended gallbladder with multiple defects that generate a posterior acoustic shadow. Therefore, it was decided to have her undergo an endoscopic ultrasound (EUS).
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This indicates that the pregnant patient has cholelithiasis plus cholecystitis and choledocholithiasis.
These case reports were carried out following the CARE strategy (Case Report) 6, which aims to illustrate how we currently have safe and effective bile duct intervention techniques in treating choledocholithiasis in pregnant women without exposure to fluoroscopy radiation.ĪLT: Alanine aminotransferase GPT: Glutamine pyruvic transaminase AST: Aspartate aminotransferase GOT: Glutamic oxaloacetic transaminase.Ī cholangio-resonance is performed ( Figure 1), documenting choledocholithiasis with obstructive effect and dilation of the intra- and extrahepatic bile duct and cholelithiasis with signs of cholecystitis.
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The estimated incidence of choledocholithiasis is rare at 1/1000 pregnancies, and its resolution is achieved with endoscopic retrograde cholangiopancreatography (ERCP) in 100 % of cases of the reviewed series 3 - 5. Complications of gallbladder stone disease during pregnancy, including cholecystitis, acute pancreatitis, and cholangitis, occur in about 10 %. An incidence of biliary sludge and cholelithiasis is estimated between 5 % to 31 % and 2 % to 11 %, respectively 4. Complications related to gallstones are common during pregnancy in fact, it is the second indication for non-obstetric surgical intervention. A prevalence of gallbladder stone disease during pregnancy is estimated between 3.3 % and 12 % 3.
Gallstone disease during pregnancy is associated with preterm labor, neonatal and maternal morbidity, and an increase in maternal and neonatal readmission 2. Gallstone disease is more common in pregnant women as it is precipitated by the high hormonal influx (increased estrogen and progesterone), which favors a decrease in gallbladder motility and an increase in saturated cholesterol in the bile-physiopathological phenomena that facilitate calculi formation and its associated complications such as choledocholithiasis 1.
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