Trans-Abdominal Ultrasound Guided ERC in a Pregnant Woman With Bile Duct Stones

Background

The change in lithogenicity of bile, increased stasis of bile and decreased gall bladder emptying are the possible reasons for an increased risk of gall stones during pregnancy. However, biliary interventions during pregnancy are associated with risks to both the pregnancy and developing fetus. ERC under fluoroscopic control as gold standard is associated with higher risk of premature labor and teratogenity.

Methods and patient

We performed transabdominal ultra-sound guided ERC in one patient in the second trimenon with gall stones. While the hilus area is observed by ultrasound, the papilla is carefully cannulated with a guidewire. A contrast agent is applied in the common bile duct (CBD) via the guide-wire of conventional duodenoscope.

Results

A rather small stone obstructing the common bile duct was visualized. To keep the invasiveness of this procedure to an absolute minimum at this time sphincterotomy with subsequent stone extraction were postponed after delivery and we decided to decompress the bile duct with a plastic stent. There were no complications due to the procedure. Bile flow was observed.

Conclusion

The exposure to radiation raises a problem in pregnant women because radiation is a possible risk for fetal disorders or premature labor, depending of the trimenon. For pregnant patients with symptomatic obstruction current guidelines recommend treatment by ERCP but with minimal exposure to radiation. This case report demonstrates a feasible alternative without fluoroscopy to the conventional fluoroscopic ERC in pregnant woman.