Would it be unwise to become pregnant?

[trauti]

I am a 32 year old female.  Approx. 4 mos. ago I started having a dull ache in my RUQ.  My doctor ordered an abdominal ultrasound which was normal:  "The gallbladder is normal without stones or wall thickening; the common hepatic duct is normal."  The liver, pancreas, abdominal aorta caliber and kidneys were normal.  There was no upper abdominal free fluid seen.  My vague pain persisted and I was sent for a HIDA scan which showed a poor ejection fraction:  "There is rapid uptake of radiopharmaceutical into a normal sized and contoured liver.  There are no focal cold defects within the liver on the hepatocyte phase.  There is prompt visualization of nondilated bile ducts at 15 minutes.  The gallbladder contracts suboptimally to Kinevac stimulation.  The global ejection fraction is 14%...There is suboptimal gallbladder contractility.  This may be due to chronic cholecystitis."  I had no pain/nausea during the scan.  All of my blood work is normal.  At this point, the "pain" I feel is much better than about 2 mos. ago when my primary care doctor rushed me to a "specialist" who was in fact a surgeon with nothing else to offer except to "pencil me in for surgery."  I am totally perplexed that I would have any problem relating to my digestion.  I have been a vegetarian for approx. 10 years and am nearly vegan (eating little/no dairy).  I even pay attention to the way I combine my food so that it is easily digested.  No one can offer me any explanation for why my gallbladder might be sluggish.  I am seeing a gastroenterologist who suggested an h. pylori test which was positive.  I'm now on a course of antibiotics to rid myself of that.  Whether or not that may have something to do with my problem is a subject of debate I understand.  I've read numerous articles relating to how h. pylori (at least the DNA) is found in gallbladder tissue and stones.  However, in general, my question is this:  Would it be unwise to become pregnant at this point.  I am loathe to have my gallbladder removed given that I'm not sure that would solve my problem.  Based on my research it seems that the "pain" associated with my condition isn't always relieved by surgery.  I have never had an episode of severe pain.  More a general "ache" and a feeling that "something's there."  I know that you can live without a gallbladder, but if I can avoid it, I'd rather not?  Your gallbladder is obviously there for a reason and I shudder to think that I might be in the small percentage who get chronic diarrhea.  Do you have any suggestions about what might be causing this problem and whether or not, given my symptoms and test results you would consider surgery to be a good option?  Also, would I be risking an emergency situation if I were to become pregnant?  Thank you!  Signed, Confused and Frustrated.

[Kevin Pho, MD]

Surgeon has kindly provided his insight in his comments below.  There are a proportion of patients with a low gall bladder ejection fraction where their symptoms are relieved with a cholecystectomy.  Some studies cite 90% of patients with improvement.  

As surgeon has mentioned, there are no guarantees - as I am not a surgeon I cannot comment on whether a cholecystectomy would help you case or not.  

Regarding the surgery, I would concur that there are no clear reasons against pregnancy.  Gall bladder problems may arise with pregancy, but it is not a contraindication at this point.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[trauti]

I appreciate both your comments Dr. Pho and surgeon.  Time is a precious commodity and I thank you both for sharing some of yours with me.

[trauti]

Thank you very much for your insight, and for taking the time to read my lengthy bio.  I really appreciate the opportunity to discuss this problem with another medical professional.  I am also glad there is a forum for people to discuss these issues in case they are dealing with the same type of problems.  You are providing a very valuable service.

[surgeon]

a low ejection fraction alone, especially with rapid filling, has a poor correlation with anything; what you describe does not sound very suggestive of gallbladder disease, and were I your surgeon, I'd advise against gallbladder removal. Nor is there any basis for recommending against getting pregnant. It's not absolutely impossible that your gallbladder is the problem, nor would it be unheard of for someone like you to develop gallbladder problems with pregnancy. But based on what you've said, I'd guess the likelihood to be very low.

[trauti]

Thanks!  I'll wait for Dr. Pho's response as well.

[surgeon]

thank you. Please note that I'm not the "official" answerer, and at some point you can expect an answer from Dr. Pho, who is. I am just someone who likes to help out; I've been a surgeon for 25+ years, and have done LOTS of gallbladder surgery.