Wife pregnant in 3rd Trimester with frequent gall bladder attacks

[bigdaddy3]

My wife, (age 40, in excellent health; non-smoker, never drinks alcohol or used any drugs, no pre-exisitng conditions), is at 31 weeks of her pregnacy with our third child, and had been diagnosed with symptomatic gallstones approximately 2 weeks ago, after 2 extreme episodes of pain in the back and URQ, and throughout her shoulder blades. She rated it on the scale as at least an 8-9, worse than labor pain, as it is constant and unpredictable. After being hospitalized, put on IV and blood work was done, gallstones were detected by ultrasound. Her OB-GYN prescribed a NON-fat diet and hydration to alleviate and hopefully prevent any further attacks. Well, this hasn't proved to be sufficient, as she has since had 4 more attacks, one lasting approx. 3-4 hours, after eating only a banana and a cup of non-fat yogurt. In the four days since, she has been afraid to eat ANYTHING and has resorted to limiting solid food to cereal with skim milk, and then only drinking non-fat smoothies and juice. Today, after eating only rice cereal w/skim milk, another attack occured, lasting about an hour. We called the OB-GYN, who now advised a liquid only diet! How can she maintain a healthy pregnancy this way? I am very concerned for her and the baby, and the doctors are telling us "no surgeon will touch her unless she exhibits constant pain or further symptoms. There has been no vomiting, fever, jaundice or other symptoms. Are there any other options short of her starving herself and our baby? It seems that the ingestion of just about anything can trigger an attack, and we are fearful of malnourishment. I have tried to pursuade her to drink meal replacement shakes, but she refuses to ingest ANYTHING with ANY fat content. Is surgery an option, and if so, what are the risks involved? Must open surgery be done due to the extent of the pregnany? And if not an option, is there any other treatment available? Any help with this matter will be greatly appreciated. Thank you.

[Kevin Pho, MD]

Surgeon has kindly addressed your question in his comments below and I agree with his assessment.

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.

[surgeon]

The main risk of surgery at this point is precipating premature labor. If that were to occur, it's likely it could be arrested by drugs. It's true surgeons prefer not to operate in the third trimester; but I've done it when the woman is unable to nourish herself adequately. It's likely an open procedure would be done; often, however, one can do a quite small incision -- a so-called "minicholecystectomy," the recovery from which is quite similar to the laparoscopic variety. Your wife might want to begin with something like gatorade; if that works, she might have the nerve to try things with both sugar and protein, like jello. There's no diet that's guaranteed to work, even a zero fat diet. Stone-dissolving pills take months to work, but sometimes they diminish the frequency of attacks, even when the stones aren't dissolved. "Actigall" (ursadiol) is one of the most commonly used pills. There is no evidence of danger to a fetus, but there aren't much data regarding use in pregnancy, so it's not done routinely.