Choledocholithiasis requiring therapeutic intervention during pregnancy is rare, estimated at one in 1200 deliveries (2).
However, choledocholithiasis may lead to cholangitis and/or gallstone pancreatitis, both of which can be detrimental to the health of both the mother and the fetus.
Indications were gallstone pancreatitis in 6 patients, choledocholithiasis on ultrasound in 5, elevated liver enzymes and a dilated common bile duct on ultrasound in 2, abdominal pain and gallstones in one patient, and chronic pancreatitis with intractable pain and a pseudocyst on magnetic resonance imaging in one.
Chronic pancreatitis was diagnosed in 63 (6.1%), cholecystolithiasis and choledocholithiasis in 549 (53.5%), stones in residual biliary duct in 249 (24.3%), stenosing papillitis in 228 (22.2%).
RESULTS: Of the 798 patients with choledocholithiasis, 764 (93.5%) had successful stone clearance, 215 (94.3%) out of 228 cases of stenosing papillitis were cured totally, while 63 had chronic pancreatitis developed from stenosing papillitis, 57 (90.1%) had sound remission of symptoms, though membranous stenosis emerged in 13 of 57 which was treated with balloon dilatation.
INTERVENTIONS: Cholecystectomy; intraoperative cholangiography for suspected choledocholithiasis: hyperbilirubinemia, gallstone pancreatitis, and ultrasonographic evidence of common bile duct dilation or common bile duct stones; and postoperative ERCP for symptomatic choledocholithiasis: pain and jaundice.
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