In a rare and highly complex medical case, a multidisciplinary team led by Dr Rao Saheb Rathod, consultant gastroenterologist and hepatologist at Medicover Hospitals, Navi Mumbai, successfully treated a 39-year-old woman who was 12 weeks pregnant with a severe, life-threatening infection caused by a gallstone blockage.
This intricate medical intervention, performed using a near-zero radiation ERCP (Endoscopic Retrograde Cholangiopancreatography) procedure, was crucial in saving both the mother and her unborn baby.
The patient, a first-time mother via IVF, came to the hospital with severe abdominal pain, vomiting, jaundice, diarrhoea, and fever symptoms that worsened despite initial treatment. At first, she had assumed it was a minor pregnancy-related stomach infection, but her symptoms soon escalated, causing her significant distress.
With her condition worsening, especially considering the high-risk IVF pregnancy, she was admitted for immediate care. Blood tests indicated a high white blood cell count, pointing to an active infection. Ultrasound findings confirmed multiple gallstones and a large stone obstructing the bile duct, leading to obstructive jaundice, a medical emergency requiring immediate attention.
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Upon diagnosis, Dr Rathod explained that the patient had choledocholithiasis with cholangitis, a life-threatening infection of the bile duct caused by a gallstone blockage.
Gallbladder stone diseases are rare in pregnancy, occurring in roughly 1 in 1200 pregnancies, and infections occur in 5-10% of these cases, say experts. “This was an extremely rare and complicated case,” says Dr Rathod. “The patient’s pregnancy was only 12 weeks along, and the first trimester is a critical period for fetal organ development. Any intervention had to ensure both maternal and fetal safety,” he added.
In treating choledocholithiasis with cholangitis, relieving the obstruction caused by the gallstone is essential, but ERCP during pregnancy presents unique challenges. Dr Rathod and his team faced the added concern of minimising radiation exposure due to the risk it poses to fetal development during the first trimester.
"ERCP with stone extraction and stenting was absolutely necessary. However, standard ERCP procedures require fluoroscopy, which involves X-ray guidance. During the first trimester, radiation exposure can cause severe developmental abnormalities such as microcephaly and intellectual disabilities," he added.
To safeguard the unborn child, the team modified their approach, using advanced techniques to limit radiation exposure. They utilised protective lead shielding and reduced imaging to a single, carefully controlled X-ray shot.
The procedure, performed within 15 minutes, was a success. Six obstructing gallstones were removed, and the bile duct was stented to prevent further blockages. After the procedure, the patient was discharged two days later.
Reflecting on the success, Sandip Joshi, Centre Head, shared, "Managing a first-trimester IVF pregnancy with acute cholangitis requires clinical expertise, technological precision, and a thorough understanding of the risks involved. This case showcases the strength of our advanced endoscopy unit and the careful coordination required to manage such a delicate and emotionally sensitive situation."