Abstract
The patient was a 37-year-old woman at 28 weeks of gestation. She presented at the hospital with epigastric pain that she experienced for 20 hours. The patient had a white blood cell count of 11300/uL and a C-reactive protein level of 1.01 mg/dL. Abdominal ultrasonography revealed enlarged gallbladder filled with stones and a thick wall. An emergency abdominal MRI was performed and the patient was admitted on suspicion of stone incarceration in the neck of the gallbladder and she was diagnosed with acute cholecystitis. On the day of admission itself, percutaneous transhepatic gallbladder aspiration was performed. Since abdominal pain did not improve after the procedure, the patient experienced onset of peritonitis concurrent with induction of labor. She underwent emergency laparoscopy-assisted cholecystectomy 6 hours after admission. Continuous drip infusion of ritodrine hydrochloride was started before surgery, and the location of the fundus of the uterus was confirmed by ultrasonography after administration of general anesthesia. The abdomen was opened at a 2 finger-width distance from the umbilicus and the gallbladder was removed by the four-trocar method. No complications were observed and the patient was transferred to the gynecology department on postoperative day 6 and discharged on postoperative day 20. She had a normal delivery at 39 weeks of gestation. Various reports on laparoscopic surgery in pregnant women over the last 10 years state that surgery can be relatively safe when performed in the second and early third trimester. Early-stage laparoscope-assisted cholecystectomy with appropriate systemic management could be a treatment option for pregnant women with acute cholecystitis.
