What happened, in summary

A healthy 27-year-old woman first developed persistent abdominal pain at 18 weeks of pregnancy. At 24 weeks, she returned with coffee-ground vomiting and upper abdominal pain. Within 48 hours, her condition worsened and emergency surgery found a 1 cm perforation in the stomach, which was repaired. She recovered after a prolonged admission complicated by infection.

Two weeks after discharge, another endoscopy found a 1 cm duodenal ulcer. At 37 weeks, she delivered a healthy boy weighing 2450 g, with Apgar scores of 9 and 10 at 1 and 5 minutes. Four weeks later, she was admitted again with vomiting, haematemesis and melaena. Endoscopy and biopsy then identified a poorly differentiated gastric adenocarcinoma. The cancer was Stage II at diagnosis; H. pylori testing was negative.

She received 1 course of radiotherapy and 3 courses of chemotherapy. A gastric stent was inserted to relieve gastric outlet obstruction. CT after chemotherapy showed a good response, and laparoscopy was planned to assess whether surgery might be possible. Before that could proceed, her condition deteriorated. She developed swelling of her arms and legs from multiple thromboses associated with Stage IV metastatic disease.

Her repeated pregnancy-related gastrointestinal symptoms had delayed recognition of the cancer. She died a few months after diagnosis.