The 39-year-old pregnant woman was diagnosed with choledocholithiasis with cholangitis , a life-threatening infection of the bile duct caused by gall bladder stone blockage which led to obstructive jaundice and required urgent medical intervention 

Gall bladder stone diseases seen in 1 in 1200 pregnancies and infection occurs in around 5-10 % of these patients

In a rare and high-risk medical case, a team led by Dr Rao Saheb Rathod, Consultant Gastroenterologist, Hepatologist & Therapeutic Endoscopist, Medicover Hospitals, Navi Mumbai, successfully treated a 39-year-old woman, who was 12 weeks pregnant, after she developed severe abdominal pain, vomiting, jaundice, diarrhea, and fever.

Investigations revealed that the 39-year-old expectant mother was diagnosed with choledocholithiasis with cholangitis, a life-threatening infection triggered by a gallbladder stone blocking the bile duct, leading to obstructive jaundice and necessitating immediate medical treatment. Given that she was in the first trimester, a critical period for fetal organ development, the medical team performed a highly controlled ERCP procedure using near-zero radiation exposure to protect the unborn child.

The patient, Mrs Karuna Shah (name changed), a 39-year-old resident of Navi Mumbai, was pregnant for the first time through IVF, a journey that was emotionally precious for her and her family. She began experiencing persistent abdominal pain, vomiting, and yellowing of the eyes when she initially thought it was a minor stomach infection related to pregnancy. She consulted a local doctor and tried basic medications, but her symptoms continued to worsen. The pain became severe, and the fever and weakness increased, causing deep anxiety about her unborn baby. With growing concern, her family decided not to delay further and rushed her to Medicover Hospital for specialized care. Due to the high-risk IVF pregnancy, she was immediately evaluated by a multidisciplinary team to ensure both maternal and fetal safety.

Dr Rao Saheb Rathod, Consultant Gastroenterologist, Hepatologist & Therapeutic Endoscopist, Medicover Hospitals, Navi Mumbai, said, “On arrival on 2nd January, the patient had pain in abdomen, fever along with obstructive jaundice, which can rapidly worsened and become life-threatening. In pregnancy, especially in IVF conception at 12 weeks, every decision must balance maternal safety and fetal protection. Blood tests revealed a high white blood cell count 21000/microlitre suggesting active infection, along with deranged liver function tests. An ultrasound examination showed multiple gallbladder stones and a large stone stuck in the dilated common bile duct, leading to obstructive jaundice. All viral markers were negative. After a detailed evaluation, she was diagnosed with choledocholithiasis with cholangitis, a life-threatening infection of the bile duct due to stone blockage that required urgent medical intervention. *Gall bladder stone diseases are seen in 1 in 1200 pregnancies and infection occurs in around 5-10 % of these patients.* She was immediately started on IV antibiotics and fluids. Cholangitis cannot be managed with medicines alone; relieving the obstruction is essential. ERCP with stone extraction and stenting was planned.”

Dr Rao Saheb Rathod further added, “ERCP during pregnancy is always challenging, but performing it in the first trimester is particularly sensitive because organ development is actively occurring. Radiation exposure during this phase can potentially cause congenital malformations such as microcephaly, eye abnormalities and intellectual disabilities. ERCP with stone extraction and stenting was planned. However, standard ERCP requires fluoroscopy (X-ray guidance), which is risky during the first trimester due to radiation exposure during organ formation. In this case, we modified our technique, used protective lead shielding, and limited imaging to a single, controlled X-ray shot. The procedure required precision, experience, and coordination. Early intervention prevented severe complications such as liver failure, sepsis, or pancreatitis, ensuring safety for both mother and baby. With careful planning and a minimal exposure strategy, we were able to successfully remove six multiple obstructing stones and stabilize the patient.”

The procedure was done within 15 minutes, and the patient was discharged on the 3rd day, after 48 hours. On follow-up after 7 days, CBC and liver function tests were done which showed completely normal results. The patient was advised to avoid a fat rich diet and visit the hospital if any fever, pain in the abdomen and jaundice recurs.

“This case highlights the strength of our advanced endoscopy unit and multidisciplinary coordination. Managing a first-trimester IVF pregnancy with acute cholangitis requires both clinical expertise and technological precision. Our focus remains on delivering safe, evidence-based, and patient-centered care, especially in high-risk and emotionally sensitive cases like this,” said Sandip Joshi, Centre Head, Medicover Hospitals, Navi Mumbai. 

“When I was told I had a serious infection during my pregnancy, I was extremely scared. This baby is very precious to us. The doctors explained every step and reassured me about the safety measures taken to protect my baby. I am deeply thankful to Dr Rao Saheb and the entire team for acting quickly and handling my case with care,” said the patient Mrs Karuna Shah (name changed)