Colecistitis durante el embarazo

Dra. Amanda Hernández Lara
Médico general.
Licenciatura en Medicina y Cirugía, Universidad de Ciencias Médicas (Ucimed) de Costa Rica. San José, Costa Rica.
Miembro del Colegio de Médicos y Cirujanos de Costa Rica.
Médico General en el Servicio de Urgencias, Hospital Clínica Bíblica. San José, Costa Rica.

Dra. Milena Mata Fuentes
Médico general.
Licenciatura en Medicina y Cirugía, Universidad de Ciencias Médicas (Ucimed) de Costa Rica. San José, Costa Rica.
Miembro del Colegio de Médicos y Cirujanos de Costa Rica.
Médico General en el Servicio de Urgencias del Hospital Clínica Bíblica. San José, Costa Rica.

Dr. Andrés Román Mora
Médico general.
Licenciatura en Medicina y Cirugía, Universidad Autónoma de Centro América (UACA). San José, Costa Rica.
Miembro del Colegio de Médicos y Cirujanos de Costa Rica.
Coordinador Médico en el Hospital Clínica Bíblica de Santa Ana. San José, Costa Rica.

Resumen

La patología biliar se considera hoy en día una de las patologías abdominales no obstétricas más frecuentes durante el embarazo. Una de sus complicaciones, en este caso la colecistitis, se caracteriza por ser la segunda patología quirúrgica más frecuente en pacientes embarazadas. Debido a esto, es una patología considerablemente significativa y que debe tomarse en cuenta como uno de los diagnósticos diferenciales de importancia cuando se valora a una paciente obstétrica con dolor abdominal agudo. Esta revisión bibliográfica consiste en analizar su fisiopatología, factores de riesgo, diagnóstico, diagnósticos diferenciales y manejo.

---

Palabras claves

Colelitiasis, embarazo, colecistitis, colecistectomía.

Abstract

Gallstone disease during pregnancy is considered one of the most common non obstetric abdominal pathologies. One of its complications, which consists of cholelythiasis, is characterized for being the second most common surgical pathologies during pregnancy. Taking into account the previously mentioned it is considerably significant and it should always be taken into account as a differential diagnosis when assessing an obstetric patient with acute abdominal pain. This bibliographic review consists in analyzing the physiopathology, risk factors, diagnosi, differential diagnosis and the management.

---

Keywords

Gall stones, pregnancy, cholecystitis, cholecystectomy.

Bibliografía

---

1. Ali A, Beckett K, Flink C. MRI emergente para el dolor abdominal agudo en el embarazo: revisión de la patología común y el aspecto de las imágenes. Emerg Radiol. 2020; 27 (2):205-14. https://doi.org/10.1007/s10140-019-01747-3

2. Álvarez-Villaseñor AS, Mascareño-Franco HL, Agundez-Meza JJ, Cardoza-Macías F, Fuentes-Orozco C, Rendón-Félix J, et al. Colelitiasis en el embarazo y posparto. Prevalencia, presentación y consecuencias en un hospital de referencia en Baja California Sur. Gaceta Médica De México, 2017, pp. 159–165. https://www.anmm.org.mx/GMM/2017/n2/GMM_153_2017_2_159-165.pdf

3. Bani Hani MN. Cirugía laparoscópica por colelitiasis sintomática durante el embarazo. Surg Laparosc Endosc Percutan Tech. 2007; 17 (16): 482-6 https://doi.org/10.1097/sle.0b013e3181379e3d

4. Bijal Parikh, Farrah Naz Hussain, & Lois Brustman. Acute Abdomen in Pregnancy. Topics in Obstetrics & Gynecology. 2019; 39(7), 1–8.

5. Guterman S, Maldelbrot L, Keita H, Bretagnol F, Calabrese D, Msika S. Laparoscopy in the second and third trimesters of pregnancy for abdominal surgical emergencies. J Gynecol Obstet Hum Reprod. 2017; 46 (5): 417-22. https://doi.org/10.1016/j.jogoh.2017.03.008

6. Al-Hashem H, Muralidharan V, Cohen H, Jamidar PA. Biliary disease in pregnancy with an emphasis on the role of ERCP. J Clin Gastroenterol. 2009; 43 (1):58-62. https://doi.org/10.1097/MCG.0b013e31818acf80

7. Hedström J., Nilsson J., Andersson R, Andersson, B. Changing management of gallstone-related disease in pregnancy – a retrospective cohort analysis. Scand J Gastroenterol. 2017; 1–6. https://doi.org/10.1080/00365521.2017.1333627

8. Hot S, Eğin S, Gökçek B, Yeşiltaş M, Karakaş DÖ. Acute biliary pancreatitis during pregnancy and in the post-delivery period. Ulus Travma Acil Cerrahi Derg. 2019; 25(3):253–8. https://doi.org/10.14744/tjtes.2019.03846

9. Ibiebele I, Schnitzler M, Nippita T, Ford JB. Outcomes of gallstone disease during pregnancy: A population-based data linkage study. Paediatr Perinat Epidemiol. 2017;31(6):522–30. https://doi.org/10.1111/ppe.12406

10. Jorge AM, Keswani RN, Veerappan A, Soper NJ, Gawron AJ. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg. 2015; 19(4):598–603. https://doi.org/10.1007/s11605-015-2757-8

11. Littlefield A, Lenahan C. Cholelithiasis: Presentation and management. J Midwifery Womens Health. 2019; 64(3):289–97. https://doi.org/10.1111/jmwh.12959

12. Mali P. Pancreatitis in pregnancy: etiology, diagnosis, treatment, and outcomes. Hepatobiliary Pancreat Dis Int. 2016; 15(4):434–8. https://doi.org/10.1016/s1499-3872(16)60075-9

13. Mukherjee R, Samanta S. Surgical emergencies in pregnancy in the era of modern diagnostics and treatment. Taiwan J Obstet Gynecol. 2019; 58(2):177–82. https://doi.org/10.1016/j.tjog.2019.01.001

14. Rios-Diaz AJ, Oliver EA, Bevilacqua LA, Metcalfe D, Yeo CJ, Berghella V, et al. Is it safe to manage acute cholecystitis nonoperatively during pregnancy? : A nationwide analysis of morbidity according to management strategy. Ann Surg. 2020; 272(3):449–56. https://doi.org/10.1097/sla.0000000000004210

15. Schwulst SJ, Son M. Management of gallstone disease during pregnancy. JAMA Surg. 2020; 155(12):1162–3. https://doi.org/10.1001/jamasurg.2020.3683

16. Vujic J, Marsoner K, Lipp-Pump AH, Klaritsch P, Mischinger HJ, Kornprat P. Non-obstetric surgery during pregnancy - an eleven-year retrospective analysis. BMC Pregnancy Childbirth. 2019; 19(1):382. https://doi.org/10.1186/s12884-019-2554-6

17. Weinstein MS, Feuerwerker S, Baxter JK. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol. 2020; 63(2):405–15. https://doi.org/10.1097/grf.0000000000000529

18. İlhan M., İlhan G., Gök, AF, Günay K, Ertekin C. The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center. Journal of Turkish Society of Obstetric and Gynecology. 2016; 13(4), 178–182. https://doi.org/10.4274/tjod.65475