BILIARY DISEASE IN PREGNANCY: A DIAGNOSTIC DILEMMA

PRIYANKA H KRISHNASWAMY; CAROL LORDEN; SAMEH MAHMOUD; HARRY KALTSIDIS; ROHIT ARORA

doi:10.22159/ijms.2021.v9i3.41050

Authors

PRIYANKA H KRISHNASWAMY Subspecialty Registrar in Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland.
CAROL LORDEN Internal Medicine Trainee, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
SAMEH MAHMOUD Speciality Registrar in Obstetrics and Gynaecology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
HARRY KALTSIDIS Gastroenterology and Pancreatobiliary Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
ROHIT ARORA Obstetrician and Gynaecologist and Honorary, Senior Clinical Lecturer, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.

DOI:

https://doi.org/10.22159/ijms.2021.v9i3.41050

Keywords:

Biliary disease, Pregnancy, Choledocholithiasis, Diagnosis

Abstract

This is a case report of a 37-year-old female who presented with deranged liver function tests, epigastric pain, fevers, vomiting, mild hypertension, and proteinuria in pregnancy. This was on a background of gestational diabetes, dyspepsia, and previous cholecystectomy. This case report highlights the importance of considering various causes of liver pathology during pregnancy besides those specifically associated with pregnancy, as well as the necessity of early specialist input to investigate symptomatic choledocholithiasis in pregnancy.

References

Maringhini A, Ciambra M, Baccelliere P. Biliary sludge and gallstones in pregnancy: Incidence, risk factors, and natural history. Ann Intern Med 1993;119:116-20.

Ko CW, Beresford SA, Schulte SJ, Matsumoto AM, Lee SP. Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy. Hepatology 2005;41:359-65.

Fesenmeier M, Coppage KH, Lambers DS, Barton JR, Sibai BM. Acute fatty liver of pregnancy in 3 tertiary care centers. Am J Obstet Gynecol 2005;192:1416-9.

Linz CM, Murphy CJ, Conteh L, Chen W, Mumtaz K. Acute fatty liver of pregnancy masquerading as choledocholithiasis. Am J Gastroenterol 2016;111:S903.

Williams E, Beckingham I, El Sayed G. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017; 66:765-82.

Pandey M, Shukla V. Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer. Eur J Cancer Prev 2003;12:269-72.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Guidelines for the use of laparoscopy during pregnancy. SAGES Guidel. 2017.

Brodsky JB, Cohen EN, Brown BW Jr., Wu ML, Whitcher C. Surgery during pregnancy and fetal outcome. Am J Obstet Gynecol 1980;138:1165-7.

Tang SJ, Mayo MJ, Rodriguez-Frias E, Armstrong L, Tang L, Sreenarasimhaiah J. Safety and utility of ERCP during pregnancy. Gastrointestinal Endosc 2009;69:453-61.

The American Society for Gastrointestinal Endoscopy (ASGE). Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012;76:18-24.

The Italian Association for the Study of the Liver (AISF). AISF position paper on liver disease and pregnancy. Dig Liver Dis 2016;48:120-37.