Hugo Bonatti, MD. University of Maryland Community Medical Group
Background: Laparoscopic cholecystectomy during advanced pregnancy is challenging due to the limited intraabdominal space. Patients may be at increased risk for developing trocar site hernia.
Case report: A 35 year old Hispanic female in her 22th week of pregnancy came to the ER with acute right upper quadrant pain. Due to lack of accessibility she had poor prenatal care. She had mildly elevated amylase but normal LFTs and ultrasound showed some gallbladder wall thickening suggestive for acute cholecystitis and no dilated biliary duct. Fetal ultrasound was normal. She was admitted to the hospital and started on antibiotics, obstetrics was consulted. Her amylase peaked at >600 U/L but then normalized and indication for laparoscopic cholecystectomy was made. MRCP and ERCP were not performed as it was assumed that the patient had passed a stone. Five mm trocars were placed in the LUQ and the umbilicus and a Teleflex minigrasper between the tow. The uterus was found at the umbilical level. The GB was pulled out and the serosa was incised on both sides and a window was created behind the GB midportion and widened towards infundibulum and fundus. There was GB wall thickening and edema. The critical view was obtained and the cystic artery and duct were clipped and divided. The common bile duct appeared normal and no IOC was done. The specimen was retrieved through the LUQ port site using a 5mm endobag after dilatation to 1.5cm due to the presence of two large stones. The port site fascia was closed using a suture passer. The postoperative course was uneventful and both mother and baby were well at the two weeks follow up.
Discussion: In case of biliary pancreatitis during pregnancy, LC should be performed and if ultrasound shows a normal biliary system and amylase/lipase normalize, MRCP/ERCP and IOC may be avoidable to protect the baby. LC with two ports is feasible during pregnancy. Removal of the specimen through a lateral abdominal wall site may help prevent an umbilical port site hernia in this patient population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88606
Program Number: P108
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster