Utilizing Percutaneous Cholecystostomy Tube as a Temporary Minimally Invasive Approach for Acute Cholecystitis during Third Trimester of a High-Risk Pregnancy

Abstract

Laparoscopic cholecystectomy (LC) is the treatment modality of choice for symptomatic cholelithiasis and cholecystitis during pregnancy and is associated with shorter length of stay, shorter operative times, and fewer complications compared to open cholecystectomy. However, in high-risk pregnant patients, LC can be challenging. Percutaneous cholecystostomy tube (PCT) offers a temporary management option during the peripartum period until interval LC is performed. We present a case of a high-risk pregnancy involving a 41-year-old woman at the 34th week of gestation with a dichorionic-diamniotic-twin gestation with signs and symptoms of acute cholecystitis. Given the patient’s high-risk status, a less intensive intervention, PCT, was performed for gallbladder decompression. An interval LC was performed on postpartum day 4 after caesarean section. Current surgical guidelines suggest that laparoscopy can be safely used to treat biliary disease during pregnancy in all trimesters. Although rarely used as a first-line intervention for gallbladder disease, PCT is an important minimally invasive procedure for treatment of cholecystitis in patients who are poor surgical candidates. Our case is unique due to the twin gestation, advanced maternal age, and gestational age.

Keywords

• percutaneous cholecystostomy
• cholecystitis
• high-risk pregnancy
• multiple gestations
• laparoscopic cholecystectomy