Y Yildirim1, N Erkan, E Avci, B Elveren. 1. Aegean Obstetrics and Gynaecology Training and Research Hospital, Department of Gynaecologic Oncology, Izmir, Turkey.
Abstract
BACKGROUND: An unique association of gastric cancer with pregnancy and puerperium is rare. CASE: A 29-year-old woman had complained of epigastric pain, postprandial vomiting and weight loss during the last 3 months of pregnancy. She first applied to our centre for premature rupture of membranes at the 38th week of gestation and underwent an emergency caesarean section because of umblical cord prolapsus. The patient developed generalised abdominal pain, distention and fever on the 2nd postpartum day. She was operated on due to acute abdomen. During surgery, generalised peritonitis with a gastric ulcer perforation at the corpus was found. The perforation area was repaired primarily. Pathological examination revealed gastric adenocarcinoma. Definitive surgery was carried out 2 weeks later. The patient received 6 cycles of adjuvant chemotherapy. After completing chemotherapy the patient was re-explored because of developing intestinal obstruction. In surgical exploration, a disseminated peritonitis carcinomatosa and extensive adhesions were observed and the patient was therefore evaluated as incurable. Postoperatively, the patient developed a high output intestinal fistula which could not be treated with palliative care. The patient died 6 months after initial diagnosis of gastric cancer. CONCLUSION: When peritonitis symptoms exist in a postpartum woman in addition to other peritonitis causes, malignant gastro-intestinal perforations such as gastric cancer perforation should be kept in mind.
BACKGROUND: An unique association of gastric cancer with pregnancy and puerperium is rare. CASE: A 29-year-old woman had complained of epigastric pain, postprandial vomiting and weight loss during the last 3 months of pregnancy. She first applied to our centre for premature rupture of membranes at the 38th week of gestation and underwent an emergency caesarean section because of umblical cord prolapsus. The patient developed generalised abdominal pain, distention and fever on the 2nd postpartum day. She was operated on due to acute abdomen. During surgery, generalised peritonitis with a gastric ulcer perforation at the corpus was found. The perforation area was repaired primarily. Pathological examination revealed gastric adenocarcinoma. Definitive surgery was carried out 2 weeks later. The patient received 6 cycles of adjuvant chemotherapy. After completing chemotherapy the patient was re-explored because of developing intestinal obstruction. In surgical exploration, a disseminated peritonitis carcinomatosa and extensive adhesions were observed and the patient was therefore evaluated as incurable. Postoperatively, the patient developed a high output intestinal fistula which could not be treated with palliative care. The patient died 6 months after initial diagnosis of gastric cancer. CONCLUSION: When peritonitis symptoms exist in a postpartum woman in addition to other peritonitis causes, malignant gastro-intestinal perforations such as gastric cancer perforation should be kept in mind.