Laparoscopic Clearance of Giant Common Bile Duct Stones in Late Pregnancy

Julio Lopez, MD, Karime Rodriguez, MD, Eduardo Targarona, MD, PhD, Ivan Corral, MD, Fernando Padilla, MD, Rene Gameros, MD, Arturo Reyes, MD

Department of Surgery, Mexican Institute of Social Security. Delicias, Chihuahua, Mexico (Drs. Lopez, Rodriguez). Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (Dr. Targarona). Department of Surgery, Mexican Institute of Social Security, Juarez, Chihuahua, Mexico (Drs. Corral , Padilla). Delegational Headquarters, Mexican Institute of Social Security, Col. Centro, Chihuahua, Mexico (Drs. Gameros, Reyes).

ABSTRACT

Introduction: The third trimester of pregnancy has long been considered a suboptimal time frame for undergoing biliary laparoscopic procedures, primarily because of maternal-fetal risks and technical issues. We present the case of a 34-year-old woman at 32 weeks’ gestation who underwent laparoscopic common bile duct (CBD) exploration and cholecystectomy to treat symptomatic cholelithiasis and giant choledocholithiasis.

Case Description: The patient was complaining of right upper quadrant pain, nausea, and vomiting. Physical examination revealed tenderness and Murphy’s sign. Liver function test results showed a pattern of obstructive jaundice, and biliary ultrasonography confirmed dilation of the CBD. Endoscopic retrograde cholangiopancreatography with sphincterotomy was unsuccessful at clearing the CBD because of the size of the stones, thus a decision was made to perform a laparoscopic CBD exploration with cholecystectomy. The patient’s postoperative course was uneventful, and she delivered a healthy girl at 37 weeks.

Conclusion: This report provides insight regarding the role that laparoscopy may play in the management of CBD stones in late pregnancy when other nonoperative alternatives have proven unsuccessful.

Key Words: Laparoscopic common bile duct exploration, Choledocholithiasis, Pregnancy, Third trimester.

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