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Table 1 Summerized information about 8 reported cases of peptic ulcer perforation after cesarean section in English literature

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

Author, year

Maternal age

GA* at delivery

Reason for cesarean section

Signs & symptoms

Diagnostic tool

Type of surgery

Outcomes

Possible predisposing factor or relevant data

Engemise [10] 2009

29

35w

Non-assuring fetal cardiotocogram in the setting of preeclampsia and obstetric cholestasis

Day 5 pp.**: serous oozing was noted from the incision site Days 6-8 pp.: diffuse abdominal pain and progressive distension, coffee ground vomiting, decreased hemoglobin level

Day 8-10 pp.: Tachycardia, diffuse abdominal tenderness, absent bowel sound, leukocytosis in the lab data

Abdominal and chest x-ray

Laparotomy (primary closure and omental patch) Re-laparotomy due to bilious leak from incision site, abdominal distension, and ongoing sepsis

Discharged 7 weeks postpartum in full recovery

Antenatal corticosteroid Oral NSAID 3 times a day for analgesia after delivery

Sule [18] 2010

27

Term

Obstructed labor

Day 3 pp.: loose stools, pyrexia and abdominal pains Day 4–11 pp.: progressive abdominal distension, pyrexia, and bilious fluid vomiting

Abdomino-pelvic ultrasound scan

Laparotomy (primary closure and omental patch) Re-laparotomy for intra-abdominal abscess drainage

Discharged 15 weeks after cesarean section in full recovery

H. pylori assay was positive

Ranganna [19] 2013

22

32w

No response to induction in the setting of eclampsia in a twin pregnancy

Epigastric discomfort since 2 days before admission

Day 1 pp.: massive abdominal distension (loop thickening, ascites, and pleural effusion in abdominal scan) Day 3 pp.: mental disorientation and fall in the blood pressure, derangement of arterial blood gas, renal function, and coagulation profile

Day 4 pp.: fever and greenish discharge from incision site (possible viscus perforation)

Computed tomography followed by peritoneocentesis (negative result)

Laparotomy (primary closure and omental patch)

Death 4 days after laparotomy

Vomiting for 1 week before admission, Epigastric discomfort since 2 days before admission

Maruyama [20] 2016

33

34w + 5d

Acute fatty liver of pregnancy

Day 2 pp.: bilateral vulvar hematoma Day 11 pp.: surgical evacuation of hematoma

Day 13 pp.: Intermittent epigastric pain postpartum, massive abdominal distension, leukocytosis in the lab data

Day 15 pp.: somnolence

Abdominal X-ray

Laparotomy (primary closure)

Discharged at the day 46 pp

Stress due to two consecutive surgeries (cesarean and hematoma drainage)

Ntirushwa [21] 2016

18

NR

NR

Day 4 pp.: Progressive abdominal distension, fever, tachycardia, dyspnea

Day 5 pp.: fever, but clinical improvement in terms of abdominal pain and tenderness Day 6 pp.: massive abdominal distension

Bed side abdominal ultrasound scan

Laparotomy (five ascaris worms were in the peritoneal cavity and stomach was perforated)

Death 4 hours after laparotomy due to septic shock

Previous unresponsive to medication epigastric pain Intestinal Ascariasis

Ntirushwa [21] 2016

34

NR

Non-assuring fetal cardiotocogram in the setting of preeclampsia

Day 1 pp.: Edema, tachycardia, dyspnea, tachypnea, abdominal distension, and tenderness (diagnosed with pulmonary edema and treated accordingly) Day 2–10 pp.: clinical improvement Day 11 pp.: hypothermia, tachycardia, tachypnea, pus aspiration in peritoneocentesis

Abdominal ultrasound scan and peritoneocentesis (at day 2 and 11 pp)

Laparotomy (primary closure in two layers) Re-laparotomy due to explore suspected leakage of the gastric repair site.

Death 2 days after re-laparotomy due to septic shock

History of epigastric pain prior to cesarean delivery

Yildirim [18] 2016

29

Term

Cord prolapse

Day 2 pp.: abrupt generalized abdominal pain and distension, poor performance status, fever, tachycardia, bile-stained purulent fluid in peritoneocentesis

Peritoneocentesis Abdomino-pelvic ultrasonography Abdomino- thoracal computed tomography Tumor markers

Laparotomy (primary closure and biopsy of the gastric site) Definitive surgery 2 weeks after emergent laparotomy; radical distal gastrectomy, lymphadenectomy and gastro-jejunostomy, since the patient was diagnosed with gastric adenocarcinoma

Death 6 month after the initial diagnosis

History of epigastric pain, postprandial vomiting and weight loss over the last 3 months of pregnancy

Levin [3] 2018

22

34w

Breech presentation

Day 4 pp.: Abrupt upper abdominal pain and coffee ground vomiting, epigastric tenderness

Computed tomography Diagnostic laparoscopy

Laparotomy

Discharged 1 week after laparoscopy in full recovery

 
  1. *GA gestational age, **PP Post-Partum