Diagnosis of Advanced Gastric Cancer Occasioned by Persistent Postpartum Fever: A Case Report

TL;DR

A rare case of advanced gastric cancer diagnosed in a woman after persistent postpartum fever and unusual symptoms during pregnancy.

Contribution

Highlights the importance of vigilance for non-specific symptoms in diagnosing rare pregnancy-associated gastric cancer.

Findings

Persistent postpartum fever and upper gastric discomfort led to the detection of stage IV gastric cancer.

Non-specific symptoms during pregnancy may indicate underlying gastric cancer and require further investigation.

Proactive ultrasound scanning can aid in early detection of pregnancy-associated gastric cancer.

Abstract

Pregnancy-associated gastric cancer is extremely rare. In many cases, the cancer is already advanced at the time of diagnosis, and the prognosis is often poor. A 39-year-old primigravida, with dichorionic diamniotic twins, was admitted to our hospital for threatened preterm labor at 31 weeks of gestation. At 32 weeks of gestation, she developed a fever and tested positive for influenza A. She recovered from influenza A on the following day but had an emergency cesarean section for premature rupture of the membranes at 32 weeks of gestation. She was discharged on postpartum day six. Thereafter, she was again infected with influenza A. On day 18, she underwent an abdominal ultrasound revealing multiple mass lesions in the liver, because she had an uncomfortable upper gastric with persistent fever. She was referred to the internal medicine team, who made a diagnosis of stage IV gastric cancer. Importantly, non-specific symptoms and physical signs that are not explicable by the normal course of pregnancy may be recognized through conscientious history-taking and physical observations. If gastrointestinal symptoms are prolonged, or if symptoms such as severe weight loss, melena, a tender abdominal mass, or persistent and unexplained fever develop, an endoscopic assessment should be conducted to suspect other diseases. In addition, proactive ultrasound scanning, including the upper abdomen, may detect pregnancy-associated gastric cancer and lead to further in-depth investigations.

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