Gastric Rupture in Pregnancy: Case Series from a Tertiary Institution in Rwanda and Review of the Literature

Abstract

Background Gastric rupture is a rare, life-threatening condition during pregnancy. Case study We present three cases of gastric perforation during pregnancy and the puerperium. The first patient presented with gastric perforation 4 days following an uncomplicated cesarean delivery for obstetric indications. She initially complained of epigastric pain; however, those symptoms resolved. She later demonstrated worsening abdominal distension, intra-abdominal free fluid, and signs of peritonitis. At laparotomy, an ascariasis-associated gastric rupture was diagnosed. She died from sepsis 4 days following the laparotomy. The second patient presented 19 days following a normal vaginal delivery. She presented with hemodynamic instability and underwent emergent laparotomy due to suspected septic shock peritonitis. Gastric rupture was diagnosed intraoperatively. She improved clinically and was discharged home. The third patient underwent emergency cesarean delivery due to non-reassuring fetal status in the setting of preeclampsia. She was initially diagnosed with ascites and pulmonary edema as a result of preeclampsia. Later in her course, she developed features in favor of acute abdomen and signs of sepsis. At the time of emergent laparotomy, a gastric rupture was identified and repaired. She died 2 days later from sepsis. Conclusion We report the management and outcome of three cases of pregnancy-related gastric rupture. To our knowledge, these three cases represent the largest series of pregnancy-related gastric ruptures from a single institution.

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.…”

“…Across the review, 3 patients died in the first week after laparotomy [19,20] and 1 died 6 months later due to gastric adenocarcinoma complications [21]. Additionally, 3 patients had prolonged hospitalization courses due to the secondary morbidity of PPU [10,18,22,23].…”

“…Additionally, 3 patients had prolonged hospitalization courses due to the secondary morbidity of PPU [10,18,22,23]. Four patients required repeat exploration after initial laparotomy for PPU; 3 for abscess washout and drainage [10,18,19] and one for gastric adenocarcinoma staging [21]. The possibility of significant morbidity and mortality shows a need for high index suspicion by the obstetricians.…”