Acute cholecystitis during pregnancy: a systematic review and meta-analysis

Background Acute cholecystitis is an uncommon non-obstetric surgical emergency in pregnancy, yet guidance on management remains inconsistent. This systematic review and meta-analysis examined presentation, diagnostics, management, and outcomes of pregnant patients diagnosed with acute cholecystitis. Methods PubMed, Web of Science, and Scopus were searched from inception to February 2024 (PROSPERO CRD42022350290). Eligible studies reported acute cholecystitis in pregnancy with individual patient data or extractable cohort data. Risk of bias was assessed in duplicates. Descriptive statistics summarised individual data, and random-effects meta-analysis generated pooled risk ratios (RR) with 95% confidence interval (CI). Results Ninety studies (1964–2023) were included: 48 case reports/series ( n = 118), 19 descriptive cohorts ( n = 5,702), 19 cohorts comparing operative versus non-operative care ( n = 91,955), and 4 cohorts comparing laparoscopic versus open surgery ( n = 62,620). Among cases with symptom data ( n = 75), right-upper-quadrant pain (40%), vomiting (33%), nausea (29%), and fever (17%) predominated. Imaging ( n = 92) most often showed gallstones (42%) and ultrasonographic cholecystitis or wall thickening (21%). Of the cases with management data ( n = 93), surgery was performed in 81 (laparoscopic 71/81; percutaneous drainage 10/81; open 1/81);12 were managed non-operatively. Of 83 with outcomes, 84% had uncomplicated courses. Meta-analysis found no significant differences between operative and non-operative care for caesarean delivery, preterm birth, postpartum haemorrhage, or composite complications, but venous thromboembolism risk was lower with surgery (RR 0.55, 95% CI 0.37–0.82), although this outcome was reported by only two studies. Conclusions Ultrasound-based diagnosis and laparoscopic cholecystectomy appear safe across all trimesters of pregnancy, with obstetric outcomes comparable to non-operative management. Operative management was associated with a lower observed risk of venous thromboembolism, although this finding was based on limited evidence. Further prospective studies are needed to optimise patient selection and surgical timing.