A unique presentation of perforated duodenal ulcer in a postpartum woman: a case report

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.