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 |  |