Gastric adenocarcinoma presenting with persistent, mild gastrointestinal symptoms in pregnancy - A case report

BACKGROUND: Mild gastrointestinal symptoms are common during pregnancy but can also be the only symptoms in stomach cancer until the late stage. Clini cians' reluctance to pursue diagnostic studies appears to be a major contri buting factor to delayed diagnosis and poor outcome. We report a case of ma ternal death to alert clinicians to this rare possibility. CASE: A 36-year-old woman had persistent, mild epigastric discomfort, nause a, vomiting and frequent episodes of dark stools since the second trimester of pregnancy. These were attributed to peptic ulcer and an iron supplement given, without investigation. Gastroscopy cons performed only at 32 weeks of gestation, when the patient had heavy hematemesis. Biopsy confirmed the diagnosis of poorly differentiated adenocarcinoma of the stomach. Cesarean section was performed after steroid therapy. Advanced stomach cancer with s tomach perforation was found. Curative surgery was not possible. The patien t died four weeks after delivery. CONCLUSION: Stomach cancer is a rare complication of pregnancy. Delay in di agnosis is commonly due to clinicians' reluctance to request diagnostic stu dies and the nonspecific symptoms of the disease. Early recognition and dia gnosis are the only possibilities for a better outcome. Clinicians must be alert to this possibility and include this in the differential diagnosis of minor gastrointestinal discomfort during pregnancy.