Laparoscopic management of cholelithiasis with choledocholithiasis in pregnancy: a case report

Choledocholithiasis during pregnancy is uncommon but potentially life-threatening for both mother and fetus if complications arise. Management poses unique challenges due to physiological and anatomical changes in pregnancy and concerns for fetal safety. Although laparoscopic approaches are generally well accepted, evidence guiding optimal management remains limited. Current guidelines on choledocholithiasis in pregnancy remain inconsistent due to limited evidence, and recommendations often emphasize individualized care depending on gestational age, symptom severity, and institutional expertise.

A 26-year-old pregnant woman at 21 weeks of gestation with a history of spontaneous abortion presented with right upper quadrant pain and nausea. Diagnosed with choledocholithiasis, she underwent laparoscopic common bile duct exploration (LCBDE) with laparoscopic cholecystectomy (LC). Surgery was successful, and the patient recovered well postoperatively, with normal fetal activity and no complications. The patient delivered a healthy male child weighing 3.2 kg at 38 weeks of gestation via lower segment cesarean section, with no morbidity or teratogenic effects observed.

This case report discusses the management of a pregnant patient in the second trimester who underwent single-stage LCBDE and LC for choledocholithiasis and cholelithiasis. We highlight key considerations, including perioperative monitoring, anesthetic modifications, and surgical techniques to ensure maternal and fetal well-being. Laparoscopic approach reduces postoperative morbidity, shortens recovery time, and minimizes fetal risks. The patient had an uneventful recovery, with favorable maternal and fetal outcomes.

This case report reinforces the feasibility and safety of laparoscopic approach to choledocholithiasis and cholelithiasis during the second trimester pregnancy.