Successful Endoscopic Management of Residual Choledocolithiasis in Pregnancy: A Case Report


The state of pregnancy generates a series of physiological changes that increase the risk of pathologies compared to non-pregnant women. At the level of the bile duct, bile salt stasis occurs, which increases the ability to generate stones. However, most patients are asymptomatic and respond adequately to expectant management and medical therapy. The rate of complications is low, with acute cholangitis, choledocholithiasis and acute pancreatitis being the indication for invasive management in obstetric patients. We present a clinical case of an obstetric patient with a history of cholecystectomy who presented residual choledocholithiasis with a subsequent episode of acute cholangitis and obstructive jaundice that required management with endoscopic retrograde cholangiopancreatography.

Choledocholithiasis or main bile duct stones are defined as the presence of stones in the common bile duct as a consequence of their formation in situ in the bile duct (primary choledocholithiasis) or secondary to the migration of stones from the gallbladder (secondary choledocholithiasis).1 Residual choledocholithiasis, a variety of secondary choledocholithiasis, is documented in less than 2% of postcolectomy patients and is defined as the presence of stones in the common bile duct less than two years after cholecystectomy.2 Pregnancy is associated with a higher incidence of stones in the bile duct, with cholelithiasis and its complications being the second cause of non-obstetric surgery in pregnant women, with an incidence of around 4%.

https://www.stephypublishers.com/sojcem/pdf/SOJCEM.MS.ID.000513.pdf

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