Scientific paperMedical versus surgical management of biliary tract disease in pregnancy
Section snippets
Methods
We reviewed the charts of all patients who were hospitalized with biliary colic (BC), acute cholecystitis (AC), gallstone pancreatitis (GSP), or choledocholithiasis (CDS) during pregnancy at the University of California, San Francisco, and at Stanford Medical Center from January 1, 1992 to January 1, 2002. Patients were identified by International Classification of Diseases, Ninth Revision code, and all patients were admitted to the obstetrical service. Data were extracted from charts of 76
Results
Thirty-one patients with 32 pregnancies at the University of California, San Francisco, and 45 patients with 46 pregnancies at Stanford Hospital and Clinics were identified. There was one twin pregnancy, one quadruplet pregnancy, and two patients who presented during consecutive pregnancies with biliary disease. Presenting diagnoses included 43 cases of BC, 20 cases of AC, 12 cases of GSP, and 3 cases of CDS. The presenting symptoms are summarized in Table 1. Fever and tachycardia were less
Comments
The appropriate management of biliary tract disease during pregnancy is controversial. Some authors advocate avoiding surgery [2], [9], [10], [11], whereas more recent studies favor aggressive surgical management [1], [7], [12]. Many of the surgical series consist of few patients over a long time period, which bridges the introduction of laparoscopic technique. We were able to accumulate a large number of patients by combining data from two major urban teaching hospitals. Presenting symptoms
Conclusion
We have shown that pregnant patients with symptomatic cholelithiasis have a high rate of symptomatic relapse during pregnancy. Relapse rates are similar for patients with BC and AC. A significant number of patients present with more severe disease at the time of relapse, including choledocholithiasis and gallstone pancreatitis. Pregnant patients with biliary tract disease should be counseled regarding the data and advised to consider cholecystectomy for symptomatic disease. Surgical management
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