Perforated duodenal ulcer in the third trimester of pregnancy, with survival of both the mother and neonate, in Ethiopia: a case report

Abstract

Background Perforated peptic ulcer disease is a serious complication of peptic ulcer disease (PUD) that presents as acute abdomen. It is very uncommon during pregnancy, but its diagnosis in pregnancy is very challenging in general, and more so in the third trimester. Timely diagnosis and prompt surgical intervention can prevent maternal and fetal mortality, but delayed diagnosis is linked with poor maternal and fetal outcomes. The aim of this case report is to emphasize the need for healthcare professionals to consider the differential diagnosis of perforated PUD when presented with cases of acute abdomen in pregnancy and to involve a multidisciplinary team in management for better feto-maternal outcome. Case presentation A 35-year-old pregnant Ethiopian woman, Gravida 7 and Para 6, presented with a sudden onset of right upper quadrant pain, nausea, and vomiting of 7 hours duration at 36 weeks of gestation. She also had contractions and leakage of liquor of two hours duration. Her abdomen was grossly distended, rigid, and diffusely tender, and showed limited movement with respiration. An upright abdominal X-ray demonstrated air under the diaphragm. She was diagnosed with perforated peptic ulcer disease. Labor was augmented, and a 2.9-kg live male neonate was delivered vaginally. Two hours after delivery, laparoscopic omental patch repair was performed. The patient was discharged 7 days after the omental patch repair surgery in stable condition. Conclusions Perforated PUD in pregnancy is a rare occurrence, which may account for the delay in diagnosis and management. Obstetricians should keep a high index of suspicion when a pregnant woman presents with acute abdomen. Care provided by obstetricians should be coupled with care provided by other disciplinary teams, in order to reduce maternal and fetal morbidity and mortality.

Úlcera péptica perforada durante el puerperio

“…Su incidencia estimada durante el embarazo es aproximadamente de 1 a 6 casos de cada 23,000 embarazos, pero la frecuencia durante el puerperio es desconocida (7) . La sintomatología habitual de la perforación duodenal puede ser escasa o estar ausente durante el puerperio y suele atribuirse a causas obstétricas (8,9) , provocando retrasos diagnósticos y terapéuticos (3) . No obstante, los estudios por imágenes pueden contribuir a un diagnóstico precoz (10) .…”

Revisión de los protocolos sobre abdomen agudo quirúrgico no obstétrico en el embarazo.

“…La úlcera péptica y sus complicaciones no suelen ser frecuentes en el embarazo, oscilando entre 1 y 6 de cada 23.000 embarazos. Los posibles mecanismos implican una secreción gástrica reducida junto con un aumento de la secreción de histaminasa placentaria (47). Las radiografías simples en bipedestación permiten detectar neumoperitoneo, aunque este puede estar ausente en el 10% al 20% de los pacientes.…”