Open AccessA unique presentation of perforated duodenal ulcer in a postpartum woman: a case report
Author(s) -
Ashali Jain,
Anthony Azzolini,
Seth Kipnis
Publication year - 2020
Publication title -
journal of surgical case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.14
H-Index - 3
ISSN - 2042-8812
DOI - 10.1093/jscr/rjaa459
Subject(s) - medicine , disease , gallbladder disease , fistula , cholecystitis , pregnancy , presentation (obstetrics) , gallbladder , incidence (geometry) , peptic ulcer , gallstone ileus , surgery , general surgery , gastroenterology , physics , biology , optics , genetics
Gallbladder disease and peptic ulcer disease (PUD) can present very similarly, and misdiagnosis can often result because of conflicting symptoms. PUD in pregnancy is relatively rare, in part due to the changes in estrogen and progesterone levels. We present a case of a postpartum female, post operation Day 5, with signs/symptoms, physical exam and laboratory work consistent with acute cholecystitis that was found to have a perforated duodenal ulcer intraoperatively. The authors suggest that a fistula would have resulted with ongoing disease. Bilio-enteric fistulas can often form due to ongoing cholelithiasis disease. Cholecystoduodenal fistulas (CDFs) are the most common fistulas to present. It is possible that the incidence of CDF formation secondary to perforated duodenal ulcers is underestimated due to signs and symptoms not presenting until gallstone ileus is diagnosed.