Rare Duodenal Ulcer Perforation Strikes During Active Labor, Case Report Finds

A 25-year-old woman giving birth vaginally experienced a duodenal ulcer perforation at the very moment she was pushing during the second stage of labor, according to a case report published in BMC Surgery. The authors state that, based on a targeted, non-systematic literature search, this is one of the few reported instances of duodenal ulcer perforation associated with spontaneous vaginal delivery, and uniquely the first described during the active second stage itself.

The patient was a primigravida at 37 weeks and 4 days of gestation with no history of abdominal surgery. She did, however, have a two-year history of self-limiting epigastric burning, a detail that would later prove clinically significant. While actively pushing during the second stage of labor, she suddenly developed severe epigastric pain.

Notably, the vaginal delivery itself proceeded without complications. The danger emerged afterward: the initially localized pain progressed to generalized peritonitis over the following hours. This progression illustrates a central diagnostic challenge the authors emphasize, namely that peritoneal signs may be masked or attributed to labor itself, delaying recognition of a surgical emergency.

Exploratory laparotomy then uncovered a defect in the anterior duodenum.

The patient’s recovery was uneventful, and she was discharged on postoperative day 8.

Given an identified risk factor, she was discharged with a prescription for Helicobacter pylori eradication therapy.

Perforated peptic ulcer during pregnancy and the puerperium is described in the report as extremely rare and potentially fatal. Diagnosis is often delayed because atypical symptoms mask the signs of peritonitis. Although perforation may occur during the intrapartum period, no cases had previously been reported during spontaneous vaginal delivery.

Alongside the case presentation, the authors reviewed sixteen previously reported patients across thirteen publications, several of which overlap with a recent systematic review. From this review they draw a practical lesson for clinicians: in cases of disproportionate or persistent abdominal pain during labor, a lower threshold for imaging is warranted, since peritoneal signs can be obscured by the normal experience of childbirth.

The report is published as an open-access case report in BMC Surgery, with the article shared early to provide faster access to peer-reviewed, accepted research. As a single case with a non-systematic literature search, the findings describe one patient’s experience rather than measured frequencies or causal effects, but they underscore how a rare abdominal emergency can unfold in parallel with an otherwise uncomplicated delivery.

Subject of Research: A case report of duodenal ulcer perforation occurring during the second stage of spontaneous vaginal delivery, with a literature review.

Article Title: Duodenal ulcer perforation during the second stage of spontaneous vaginal delivery: a case report and literature review

Article References: Salehi, A. M., Tajik, A., & Hosseini, S. R. (2026). Duodenal ulcer perforation during the second stage of spontaneous vaginal delivery: a case report and literature review. BMC Surgery. https://doi.org/10.1186/s12893-026-04303-2

Image Credits: AI Generated

DOI: 10.1186/s12893-026-04303-2

Keywords: duodenal ulcer, perforation, vaginal delivery, second stage of labor, peritonitis, pneumoperitoneum, Graham omental patch, Helicobacter pylori, pregnancy, case report, BMC Surgery, exploratory laparotomy