Background Peptic ulcer disease is relatively uncommon in pregnancy and the perperium. Vomiting on the other hand is a common symptom. We present a case of an acute abdomen which was secondary to a perforated Gastric ulcer in Pregnancy.

Case A 40 year old para 2 (2 previous caesarean sections) booked under our care with a monochorionic monoamniotic twin pregnancy. She was a known smoker and had previous use of cocaine and marijuana use. She had an uneventful 1^st and 2^nd trimester but at 32 weeks presented with a 6 week history of vomiting that was initially managed conservatively with antacids and rehydration. This persisted to 35 weeks where she presented with excess vomiting and an acute abdomen. Chest X-ray and Ultrasound failed to identify a cause. She continued to deteriorate hence underwent an emergency caesarean section. Intraopertively turbid free fluid was noted. The general surgeons were called. A perforated lesser curve gastric perforation of 20mm in the pre-pyloric region was found which was repaired.

Conclusions Nausea and vomiting are common symptoms of pregnancy and as such prolonged episodes that lead to an acute abdomen can be difficult to diagnose easily. A low threshold for other pathologies should be considered in women who present with protracted illness in pregnancy. Multi-disciplinary team involvement can also be beneficial in these cases.