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CHOLEDOCHOSCOPY AS A TREATMENT OF CHOICE IN RESIDUAL CHOLEDOCHOLITHIASIS IN PREGNANCY; ONE CASE REPORT

Jurez de la Torre Juan Carlos, Guilbert Vrtiz Lizbeth, Alberto Aquino Gonzlez, Lpez Loredo lvaro, Heredia Montao Mnica. Servicio de Ciruga General, Hospital Universitario de Puebla, Puebla, Mxico

Background: Acute cholecystitis affects up to 10% of pregnant women. The 90% is secondary to biliary sludge or stones. Pregnancy tone and contractility decreases gallbladder, which along hijacking cholesterol crystals leads to lithogenesis. Cholestasis during pregnancy increases fetal morbidity, mortal being up to 11%, with aspiration of meconium by 27%, changes in heart rate in 14% and pre-term delivery by up to 36% of cases. Case presentation: Female patient, 25 years old currently studying normal pregnancy of 22.3 weeks pregnant by LMP, prior cesarean section 2 years ago by cephalo pelvic disproportion and abortion at 14 weeks of pregnancy. Appendectomy for 6 years without complications. Start your condition for 40 days prior to admission with skin and conjunctival jaundice, dark urine acolia and without abdominal pain or fever. Open cholecystectomy is performed in another hospital unit, leaving probe "T" to bypass spending approximately 200 ml daily since then. The patient remained jaundiced, acolia, without dark urine or pain or other symptoms, which came to our hospital. Results: We performed percutaneous choledochoscopy finding five litos distributed right and left hepatic ducts and distal common bile duct at the level of ampulla of Vater by withdrawing the entire basket slept yet bilirubin levels remain constant at ERCP is performed colangioresonancia found no evidence of residual stones, at 5 days post choledochoscopy bilirubin levels drop to normal ranges. Conclusions: intrahepatic stones represents a potential risk to the mother and child. Although ERCP and colangioresonancia are diagnostic and / or therapeutic tools, the risk of product exposure to ionizing radiation and electromagnetic fields remains controversial. The use of percutaneous choledochoscopy has a success rate ranging from 86 to 96% and lower incidence of complications than conventional therapeutic means, because this is the most

recommended treatment in patients with intrahepatic stones or have a history previous biliary surgery.
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