Clin Endosc.  2018 May;51(3):294-298. 10.5946/ce.2017.152.

An Unusual Case of Ovarian Carcinomatosis with Microscopic Tumor Embolism Leading to Rectal Ischemia and Perforation

• Tang MH
• Lim J
• Bushmani I
• Ng CY

• KMID: 2414873
• DOI: http://doi.org/10.5946/ce.2017.152

Abstract

We present an unusual case of advanced ovarian carcinoma with postoperative complications of ischemia and perforation of the rectum as a result of tumor embolism. The interval progression from ischemia to infarction of the rectum was captured in repeated sigmoidoscopies. A brief discussion on tumor embolism and management of this case is also included.

Keyword

Ovarian neoplasms; Neoplastic cells; Rectum; Ischemia; Perforation

MeSH Terms

Carcinoma*
Infarction
Ischemia*
Neoplastic Cells, Circulating*
Ovarian Neoplasms
Postoperative Complications
Rectum
Sigmoidoscopy

Figure

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  Fig. 1. Extensive mucosal dissection (A, B) and flap (C, D) at the right posterolateral aspect throughout the entire rectum during sigmoidoscopy.

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  Fig. 2. Initial chest (A) and abdominal (B) X-rays showing no pneumoperitoneum.

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  Fig. 3. Interval sigmoidoscopy showing (A) normal colonic lumen distally, (B) inflamed mucosa with bleeding, (C) mucosal dissection with ischaemia, (D) extensive colonic ischaemia with perforation.

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  Fig. 4. A computed tomography mesenteric angiogram showing communication of the anterior rectal wall with the vagina vault with faecal material seen within.

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  Fig. 5. Histopathology of the resected rectum all stained with hematoxylin and eosin stain. (A) Rectal wall full thickness infarction with small perirectal tumour emboli and metastatic deposits at magnification of ×20. No malignant cells are present in the wall. (B) Tumour vascular embolus within perirectal fat shown with an arrow at magnification of ×40. (C) High power view to illustrate tumour cells of serous epithelial type at magnification of ×40.

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