Post-Cesarean Gastric Rupture

Abstract

Background: Although rare, acute gastric dilatation is associated with life threatening complications. While several cases have been documented in various settings, there are very few cases documented in association with gynecological surgeries. Objective: We report a case of acute gastric dilatation with subsequent necrosis and perforation in 35-year-old postpartum patient two days following a primary cesarean section. The patient’s medical history was significant for diabetes and intellectual disability. Despite treatment and resuscitative measures following gastric rupture, the patient continued to decompensate, suffering respiratory failure, anoxic brain injury, and subsequently death. Conclusion: Gastric necrosis is a postoperative complication of which any surgeon should be aware. While there are very few documented cases of gastric necrosis and perforation after gynecologic surgery, pelvic surgeons should still be cognizant of this often fatal complication. Obstetricians must maintain a high suspicion of ileus in any post-cesarean patient with nausea or vomiting, particularly in patients with a history of diabetes mellitus and intellectual impairment who are at risk for gastric necrosis. Awareness of this potential complication may help providers initiate treatment modalities quickly, thus reducing mortality.