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.