Duodenal Perforation in a Lady with Twin Gestation and Severe Preeclampsia

Abstract

We present a case where the clinical manifestation of a duodenal perforation was masked by preeclampsia during the initial workup. A 22 year G2A1, 32 weeks pregnant female presented with symptoms of impending eclampsia and blood pressure of 190/120 mm Hg. Emergency cesarean section was done for failed induction. Subsequently, she developed subacute bacterial peritonitis leading to acute renal failure and disseminated intravascular coagulation. On post-operative day 4, the abdominal wound dressing was stained with greenish yellow discharge when the possibility of a perforated viscus was made. Laparotomy was done on day 6 and a perforation was seen on the anterior part of duodenum. Being vigilant to make an early diagnosis and intervention can reduce the maternal morbidity and mortality associated with duodenal perforation which is a rare occurrence during pregnancy.

Two Cases of Gastroduodenal Perforation Following Cesarean Section

“…The hematological and biochemical derangements as well as clinical features culminated in a SOFA score of 6 on admission. The association between hypertensive disorders in pregnancy and gastroduodenal perforation is not clear [16]. The first case had pregnancy-induced hypertension and the second case imminent eclampsia.…”

“…At the time of diagnosis of imminent eclampsia, the second patient had epigastric pain. Ranganna et al reported a case of duodenal perforation in a nullip with twin gestation with imminent eclampsia in whom the clinical manifestation of the perforation was masked by that of the imminent eclampsia [16]. Perforation leads to chemical peritonitis and this can lead to shock, electrolyte imbalance, sepsis and acute kidney injury all of which may be potentially fatal [13].…”

“…Some other underlying causes of gastroduodenal perforation have been reported but remain largely rare. These include gastric carcinoma, ingestion of sharp foreign material, opportunistic infections, metastatic cancer, eating disorders and pregnancy [14][15][16]. We report two cases of gastroduodenal perforation diagnosed at laparotomy on the seventh (case 1) and 12th (case 2) day post cesarean section in two young women.…”

Peptic ulcer perforation after cesarean section; case series and literature review

“…The most common clinical signs and symptom were progressive abdominal distension, abdominal pain and tenderness, tachycardia and fever. Two patients were diagnosed with preeclampsia [10,19] and one with eclampsia [20]. Signs and symptoms of peptic ulcer in these cases were primarily attributed to preeclampsia features.…”

“…Peritoneocentesis was performed in three cases [19][20][21] and was diagnostic in two [19,21], resulting in laparotomy. Peritoneocentesis may be a practical tool to rule out hemoperitoneum.…”