title: Gastric Rupture in Pregnancy: Case Series from a Tertiary Institution in Rwanda and Review of the Literature.
abstract: BackgroundGastric rupture is a rare, life-threatening condition during pregnancy.Case studyWe 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.ConclusionWe 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, Rwanda; Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda.
authors.forename: David
authors.initials: D
authors.lastname: Ntirushwa
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, Rwanda.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rulisa
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, Rwanda.
authors.forename: Febronie
authors.initials: F
authors.lastname: Muhorakeye
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, Rwanda; Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Obstetrics and Gynecology, Yale University, New Heaven, Connecticut.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bazzett-Matabele
authors.affiliation: Rwanda Military Hospital, Kigali, Rwanda.
authors.forename: Theogene
authors.initials: T
authors.lastname: Rurangwa
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, Rwanda; Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; Department of Obstetrics and Gynecology, Yale University, New Heaven, Connecticut.
authors.forename: Maria
authors.initials: M
authors.lastname: Small
keywords: Rwanda; ascariasis; gastric rupture; pregnancy; sepsis