Neglected and Persistent Vomiting of Pregnancy: Can it be Malignancy

Background: Nausea and vomiting is a common entity of pregnancy. 7 out of 10 women experience some level of NVP. Gastric cancer with pregnancy in one of a rarest cause of NVP complicating pregnancy worldwide. Case: A 25 years primigravida presented to Dr. Bhimrao Ambedkar Memorial hospital with severe IUGR and severe vomiting, tolerating liquid diet only. She was thin built, brittle discolored rough hairs with cracked lips and angular cheilosis. She had tachycardia but BP was normal. All her routine investigations were within normal range except mildly elevated liver enzymes. She was investigated for her persistent vomiting with consultation from physician and surgeon. USG whole abdomen was done to rule out other causes of vomiting which showed thickening of stomach wall. MRI suggested asymmetrical circumferential thickening of antropyloric region of stomach. Endoscopic biopsy showed diffuse infiltrative adenocarcinoma (signet ring cell). Her nutritional deficiency was managed. She had preterm vaginal delivery and baby was handed over after 35days of birth. She received neoadjuvant chemotherapy followed by surgery and radiotherapy and chemotherapy. She is living normal day to day life now. Conclusion: Severe, persistent and nonresponsive NVP associated with weight loss should be investigated vigilantly and thoroughly. Apart from other causes one of rarest cause i.e., gastric carcinoma should not be missed. Diagnosis in early stage and management can have better prognosis and prolong the life expectancy.