Gastric Adenocarcinoma in a Pregnant Woman at 33 Weeks of Gestation: A Case Report of Krukenberg Tumor Complicated by Uterine Rupture

A 34-year-old woman, gravida 2 para 1, presented at 33 weeks of gestation with significant weight loss, anorexia, abdominal pain, and a single episode of hematemesis. On examination, she appeared cachectic, with generalized abdominal tenderness. Imaging revealed bilateral adnexal masses and ascites, and endoscopy identified a gastric mass. Biopsy confirmed signet-ring cell adenocarcinoma. Laboratory workup showed elevated cancer antigen 125 and hypoalbuminemia. Plans were made to deliver at 37 weeks to maximize fetal maturity. However, at 35 weeks, she developed acute abdominal pain and fetal bradycardia. Emergency laparotomy revealed uterine rupture. A total hysterectomy with bilateral salpingo-oophorectomy was performed. The infant, delivered with no signs of life, died four days later despite supportive care. Histopathology confirmed Krukenberg tumors (bilateral ovarian metastases) and peritoneal spread. Postpartum positron-emission tomography/computed tomography revealed osseous metastases. The patient commenced treatment with folinic acid, fluorouracil, and oxaliplatin version 6 and nivolumab, later receiving palliative radiotherapy and transitioning to paclitaxel. This case captures the diagnostic and therapeutic challenges of managing advanced gastrointestinal cancer in late pregnancy. It also highlights the emotional and clinical weight of navigating maternal care amid rapidly evolving disease and obstetric emergencies. Multidisciplinary coordination was critical throughout her journey.