Clinical pancreatitis is a life-threatening illness which can result in DIC, internal hemorrhage, and death. Milder forms of pancreatitis can result in clinical diabetes, as the Islands of Langherans are destroyed by the retention of digestive enzymes. When patients have clinically significant pancreatitis as the result of gallbladder disease, then cholecystectomy should be considered for the patient. The majority of literature regarding cholecystectomy during pregnancy predates the widespread use of laparoscopic cholecystectomy. Therefore, the complications thought to be associated with cholecystectomy such as premature labor may not be as frequent.
Laparoscopic cholecystectomy is the procedure of choice.
Technical considerations in the late third trimester may prevent laparoscopic cholecystectomy based on uterine size. Adjunctive treatment with tocolytics should be considered whenever a patient undergoes major surgery during pregnancy. The choice of the tocolytic should be the discretion of the obstetrician. Fetal heart tones should be auscultated both prior to and following surgery to assure that fetal demise does not occur as a result of the surgical procedure. It is appropriate to consider medical treatment of gallbladder disease during pregnancy in the absence of clinically significant pancreatitis.