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Z Gastroenterol 2011; 49(4): 452-460
DOI: 10.1055/s-0029-1245995
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Symptomatische Choledocholithiasis in der Schwangerschaft – Einsatz der Sonografie, ERCP und EUS

Symptomatic Choledocholithiasis during Pregnancy – the Role of Ultrasound, ERCP and EUSU. Gottschalk1 , E. Gottschalk2 , C. F. Dietrich3
  • 1Abteilung Innere Medizin, Maria Heimsuchung Caritas Klinik Pankow
  • 2Klinik für Geburtsmedizin, Charité, Campus Virchow
  • 3Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim
Further Information

Publication History

Manuskript eingetroffen: 12.8.2010

Manuskript akzeptiert: 17.12.2010

Publication Date:
07 April 2011 (online)

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Zusammenfassung

Anhand einer akuten biliären Pankreatitis bei einer hochschwangeren Patientin wird ein Überblick über die notwendige Diagnostik und die endoskopische Therapie gegeben. Insbesondere der Sonografie kommt eine zentrale Stellung für das weitere Prozedere zu. Gelingt es nicht, aus Klinik, Laborchemie und perkutaner Sonografie eine ausreichend fundierte Entscheidung zu treffen, so stellt die Endosonografie (oder die extraduktal applizierte Minisondentechnik) die Methode der Wahl für das weitere diagnostische Vorgehen dar. Diese invasive diagnostische Methode sollte jedoch in ERCP-Bereitschaft erfolgen, um hier zum Schutze des Fetus schnell und mittels nur einer Sedierung der Mutter zum definitiven Ergebnis zu kommen. Da eine ERCP in der Schwangerschaft immer eine Belastung für Mutter und Fetus darstellt und die Strahlenbelastung so gering wie möglich gehalten werden sollte, ist dieser Eingriff, da er unter Zeitdruck erfolgt, grundsätzlich nur von erfahrenen Untersuchern durchzuführen. Unter optimalen Bedingungen stellen Endosonografie und ERCP auch in der Schwangerschaft risikoarme Eingriffe dar.

Abstract

We present an overview of the management of acute bilary pancreatitis in pregnancy with particular reference to endoscopy. Ultrasound is the gold standard for diagnosis. If clinical symptoms, laboratory parameters and transabdominal ultrasound do not allow appropriate decision making, endoscopic ultrasound (EUS) is the method of choice. EUS is preferably performed prior to ERCP during the same clinical session, this is of particular relevance for pregnant women with regards to the safety of mother and fetus. However, because the procedure is performed under fluoroscopic guidance, there are potential risks related to the radiation exposure. ERCP, especially in pregnant patients demands high expertise from the endoscopist, and with due diligence and attention to detail, the procedure can be safely performed.

Schlüsselwörter

Schwangerschaft - Cholelithiasis - Choledocholithiasis - Pankreatitis

Key words

pregnancy - cholelithiasis - choledocholithiasis - pancreatitis

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Prof. Dr. Christoph F. Dietrich

Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim

Uhlandstr. 7

97980 Bad Mergentheim

Phone: ++ 49/79 31/58 22 01

Fax: ++ 49/79 31/58 22 90

Email: christoph.dietrich@ckbm.de

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