Case-report:
A 53-year-old woman with no relevant medical history, consulted for hypogastric pain of progressive onset since one week without spontaneous tendency to stop. On examination, she was febrile at 39.1°c, abdominal palpation revealed a warm painful mass whose upper limit was abutting the umbilicus. The biology noted a major inflammatory syndrome with WBC=16460/mm3, CRP=340mg/L. Abdominal CT demonstrated a well-limited, partitioned, retro-uterine pelvic mass measuring 200x154mm with an air-liquid image of left ovarian origin. She underwent an urgent surgery via a midline incision. Operative finding were as followed: inflamed ascites, a tumor-like swollen left ovary attracting adhesions with the last two ileal loops and invading the sigmoid colon whose contact surface is also affected along multiple lymph nodes lining the lower mesenteric artery. It was decided to perform an en-bloc resection with sigmoidectomy, creation of an end-loop colostomy considering the introduction of noardrenalin and anemia, total hysterectomy, bilateral oopohorectomy, peritonectomy of 2 pelvic parietal nodules, infra-gastric omentectomy and lombo-aortic curage; leaving no macroscopic residual disease pelvic. After an initial stay in the intensive care unit, she was returned to the ward with successful cessation of cathecolamines. Antibiotic therapy was maintained for 7 days with a combination of cefotaxime, metronidazole and gentamicine. The postoperative recovery was without complications and thepatient was discharged on postoperative Day 7. Anapath examination was consistent with a high-grade serous adenocarcinoma infiltrating the colonic wall. She had adjuvant chemotherapy. In the absence of tumor regrowth or secondary localization on the follow-up CT scan, she was scheduled for stoma reversal surgery 5 months later. At follow up consultation, the patient is symptom-free with no evidence of recurrence on reassessement CT after 3 months.