Acute cholecystitis in pregnancy

Acute cholecystitis is the most common non-obstetric abdominal emergency in pregnant patients. It is a consequence of increased formation of cholelithiasis, and occurs due to inflammation of the gallbladder, usually caused by the blockage of the cystic duct. There is also described the appearance of cholecystitis without the presence of gallstones, and this is named as acalculous cholecystitis. Elevated levels of estrogen and progesterone are thought to be a cause of women’s increased predisposition to this condition. In pregnancy, literature describe the appearance of gallstones in 1% to almost 3% pregnancies, and it is known that pregnancy by itself affects the contractility of gallbladder. For sludge and gallstones, even if there is a large range of symptoms, almost up to 50% of patients are asymptomatic. Acute cholecystitis is suspected in a patient with continuous pain in the right upper quadrant, alongside anorexia, vomiting, and fever. Laboratory findings in acute cholecystitis show leukocytosis, an elevated level of bilirubin, up to 4 mg/dl and elevated liver tests. The most useful imaging tool in diagnosing gallstones and further acute cholecystitis is an abdominal ultrasound. Any pregnant women with upper right quadrant pain should be hospitalized to exclude other differential diagnoses and for pain management, usually done with acetaminophen. Supportive care treatment includes administration of intravenous fluids and when necessary antibiotic therapy. Recent studies have showed that interventional surgery by itself brings some associated risks during pregnancy, but with an experienced team of surgeon, anesthesia specialist, and obstetrician, outcomes are better, no matter the trimester of pregnancy.