Yamakoshi Yoshihito, Aomatsu Naoki, Yamasaki Noriyuki, Nobori Chihoko, Kurihara Shigeaki, Wang En, Nagashima Daisuke, Hirakawa Toshiki, Iwauchi Takehiko, Morimoto Junya, Tei Seika, Nakazawa Kazunori, Uchima Yasutake, Takeuchi Kazuhiro
Dept. of Surgery, Fuchu Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):2438-2440.
A 50-year-old post-menopausal woman with sudden lower abdominal pain was transported to hospital by ambulance. Abdominal symptoms and computed tomography(CT)suggested a diagnosis of acute pan-peritonitis due to gastrointestinal perforation, and emergency surgery was performed. The intraoperative findings led to a diagnosis of a ruptured cyst in the left ovary, a portion of which was observed to be partially solid, and therefore, ovarian cancer was suspected. Accordingly, a unilateral(left)salpingo-oophorectomy and intraperitoneal drainage were performed with assistance from a gynecologist. Following a diagnosis of ovarian clear cell adenocarcinoma based on histopathological examination, the patient underwent further debulking surgery at a later date, followed by postoperative chemotherapy. In acute pan-peritonitis associated with a large quantity of ascites in women, the rupture of ovarian tumors should be considered as a possible etiology. The therapeutic strategy for ovarian cancer is determined according to post-operative staging, even during emergency surgery. It is therefore important not only to repair the rupture, but also, if possible, to perform a diagnosticbiopsy or resection.
一名50岁的绝经后女性因突发下腹部疼痛被救护车送往医院。腹部症状和计算机断层扫描（CT）提示诊断为胃肠道穿孔所致的急性全腹膜炎，并进行了急诊手术。术中发现诊断为左卵巢囊肿破裂，其中一部分观察到部分为实性，因此怀疑为卵巢癌。于是，在妇科医生的协助下进行了单侧（左）输卵管卵巢切除术和腹腔引流。经组织病理学检查诊断为卵巢透明细胞腺癌后，患者在之后接受了进一步的肿瘤细胞减灭术，随后进行了术后化疗。在伴有大量腹水的女性急性全腹膜炎中，应考虑卵巢肿瘤破裂为可能的病因。卵巢癌的治疗策略根据术后分期确定，即使在急诊手术期间也是如此。因此，不仅要修复破裂处，而且如果可能的话，进行诊断性活检或切除也很重要。
