Unusual case of hyperemesis in a pregnant patient with prior antireflux surgery

A 33-year-old, 8 weeks pregnant, presented with severe upper abdominal pain with vomiting on a background of a previous laparoscopic Nissen fundoplication for reflux disease. An urgent MRI had shown herniation of the fundoplication wrap through the diaphragmatic hiatus. The cause of her symptoms was...

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Bibliographic Details
Published in:BMJ case reports 2021-08, Vol.14 (8), p.e241935
Main Authors: Obisesan, Abimbola, Townsend, Eleanor Lucy, Wong, John Lin Hieng, Menon, Vinod
Format: Article
Language:English
Subjects:
Abdomen
Blood tests
Case Report
Case reports
Hemoglobin
Hernias
Ischemia
Nausea
Pain
Patients
Pregnancy
Stomach
Surgery
Uterus
Veins & arteries
Vomiting
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Summary:A 33-year-old, 8 weeks pregnant, presented with severe upper abdominal pain with vomiting on a background of a previous laparoscopic Nissen fundoplication for reflux disease. An urgent MRI had shown herniation of the fundoplication wrap through the diaphragmatic hiatus. The cause of her symptoms was attributed to hyperemesis gravidarum. The plan was to manage this patient conservatively until the conclusion of her pregnancy. This plan was revised when she presented for the second time and developed worsening pain and haematemesis. An emergency gastroscopy showed ischaemic changes in most of the stomach requiring the patient to undergo an emergency laparotomy. In pregnant patients, presenting with abdominal pain, vomiting as well as haematemesis, having had previous antireflux surgery, incarceration of the stomach must be considered as a differential. Prompt assessment and early senior decision-making is extremely important in avoiding a potentially catastrophic outcome for such patients.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-241935