| Abstract [eng] |
Introduction. Acute cholecystitis is an inflammatory disease of the gallbladder, most commonly caused by gallstone obstruction. Hormonal and physiological changes during pregnancy increase the risk of gallstone formation. Although this condition is rare, it is clinically significant because of possible maternal and fetal complications. Nonspecific symptoms complicate the diagnosis, while the choice of treatment strategy remains controversial. Objective. To review the pathogenesis, diagnostic and therapeutic aspects of acute cholecystitis during pregnancy, and to evaluate the impact of conservative and surgical treatment on maternal and fetal outcomes. Objectives. 1) To analyze the pathogenesis and risk factors of acute cholecystitis during pregnancy; 2) to describe the clinical, laboratory, and radiological diagnostic features of acute cholecystitis during pregnancy; 3) to review the currently applied treatment methods for acute cholecystitis during pregnancy and their indications; 4) to compare the outcomes of conservative and surgical treatment by evaluating the risk of maternal and fetal complications as well as pregnancy outcomes. Methods. A literature review was conducted using the PubMed and Google Scholar databases, employing keywords related to acute cholecystitis during pregnancy, its diagnosis, management and maternal and fetal outcomes, and a clinical case treated at Vilnius University Hospital Santaros Clinics was described. Results. The literature analysis showed that most cases of acute cholecystitis during pregnancy are associated with gallstone disease, and the main predisposing factors are estrogen- and progesterone-induced changes in bile composition and gallbladder motility. Diagnosis is based on a combination of clinical symptoms, laboratory findings, and imaging studies, of which ultrasonography is the most important. Conservative treatment is more often associated with disease recurrence, repeated hospitalizations, and a higher risk of adverse pregnancy outcomes. Laparoscopic cholecystectomy is considered a safe and rational treatment method in all trimesters of pregnancy. The reported clinical case involved a 30-year-old pregnant woman who was diagnosed with acute calculous cholecystitis at 13 weeks of gestation. The disease presented with nonspecific clinical symptoms, which complicated timely diagnosis. Conservative treatment was initially applied, but due to persistent symptoms, laparoscopic cholecystectomy was performed. The subsequent course of pregnancy was uneventful, and no complications were identified. Conclusions. The diagnosis and treatment of acute cholecystitis during pregnancy require comprehensive clinical assessment. In the presence of persistent symptoms or ineffective conservative treatment, surgical management should be considered in a timely manner. Properly selected treatment allows favorable maternal and fetal outcomes to be achieved. Keywords: acute cholecystitis, pregnancy, cholelithiasis, laparoscopic cholecystectomy, conservative treatment. |
