Table 1 Summary of reported cases of perforated peptic ulcer disease in pregnancy and the outcomes

Essilfie et al. (2011) [1]

27

38

Recurrent episodes of vomiting, general malaise, back pain, and vague lower abdominal pain that later localized to upper abdomen

Significant tenderness in the epigastrium

No significant medical history and was not on medication

Ultrasound showed fluid collection in the right upper quadrant of abdomen

Chest X-ray was normal

Laparoscopy revealed copious amount of pus and extensive adhesion around the stomach

Laparotomy revealed anterior perforation of the second part of duodenum which was repaired and omental patch support created

The delivery was with ventouse and both mother and neonate survived and were discharged on the 7th postoperative day in stable condition

Goel et al. (2014) [7]

25

32

Sudden onset severe abdominal pain and nausea but no vomiting

Generalized distension with guarding and tenderness, and absent bowel sounds

No known predisposing factor for PUD

Abdominal ultrasound revealed distended bowel loops and mild collection of fluid in peritoneal cavity

Possibility of acute pancreatitis was considered and conservatively managed, but no response and laparotomy was decided upon. Intraoperative there was 2.5 L of bile-stained purulent pus in the peritoneal cavity and a 3-cm-long perforation on the first part of the duodenum which was repaired and omental patch support created

Labor started s few hours after laparotomy and a stillborn male neonate weighing 1.8 kg was delivered vaginally

The mother was discharged on her 7th postoperative day in improved condition

Gali et al. (2011) [10]

16

28

Sudden persistent epigastric pain for 2 days, associated with nausea and vomiting; this occurred during Ramadan fasting period for the Muslims and she was fasting

Abdominal examination showed generalized tenderness with guarding, bowel sounds absent

No known predisposing factor for PUD

Air under the diaphragm was detected on the chest X-ray

Laparotomy done and revealed 1 L of gastric juice mixed with blood, food debris, and a 1-cm-long perforation on the first part of the duodenum

The perforation was closed with omental patch

Labor started 3 days after laparotomy and a living male neonate weighing 1 kg was delivered vaginally, who died 3 days after admission to the special care baby unit

The mother developed wound infection which was managed with antibiotics and wound dressing was and discharged 21 days after surgery

Gebremariam et al. (2015) [3]

20

28

A 1-day history of supra-umbilical abdominal pain, abdominal distension, and repeated vomiting of coffee ground nature

Abdominal examination showed grossly distended tender abdomen

Had history of chronic epigastria discomfort for which she sought no medical advice a or treatment

Initially intestinal obstruction was considered and plain abdominal X-ray was done which showed no any remarkable finding

Laparotomy decided upon and intraoperative 2 L of gastrointestinal content and a 1-cm-long anterior wall perforation on the first part of duodenum was found

Omental patch was done for the perforation

Postoperatively, induced for severe preeclampsia and delivered vaginally a 1.9-kg dead male neonate

The patient was discharged in an improved condition and had no complaints during subsequent follow-up

Erez et al. (2004) [11]

27

35

Protracted nausea and vomiting and later development of abdominal pain and tenderness

Maternal bariatric surgery (gastric banding)

The patient was initially diagnosed and treated for a small bowel obstruction but hours later developed acute abdomen and non-reassuring fetal testing.

Exploratory laparotomy and cesarean delivery performed.

A perforated gastric ulcer was diagnosed and repaired

Emergency cesarean section was done during laparotomy

Both mother and neonate survived and discharged home with stable condition

Our case (2022)

35

36

Sudden onset right upper quadrant pain of 7-hours duration that radiated to the back, associated with nausea and vomiting

Abdominal examination showed grossly distended, rigid, and diffusely tender abdomen, which showed limited movement with respiration

She had history of intermittent burning type of epigastric pain prior to pregnancy

An upright abdominal X-ray was performed and demonstrated air under diaphragm

Ultrasound revealed massive amount of intraperitoneal fluid

Laparotomy was done and revealed a copious amount of thin pus in the abdominal cavity, and a 0.5 × 0.5-cm anterior perforation of the first part of the duodenum, which was repaired, and omental patch (Graham’s patch) support was created

Delivered vaginally a 2.9-kg living male neonate with Apgar score of 5 and 8 in the first and fifth minutes, respectively following augmentation with oxytocin

The mother and the neonate were discharged 1 week later in stable condition