Siala Rakia, Mseddi Mohamed A, Yaakoubi Chaima, Kassar Alia Z, Guizeni Rami, Slima Mohamed B
General Surgery Department "B", The Faculty of Medicine, The University of Tunis El Manar, La Rabta Hospital.
Anatamopathology Departement, The Faculty of Medicine, The University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia.
Ann Med Surg (Lond). 2024 Jul 1;86(8):4845-4848. doi: 10.1097/MS9.0000000000002267. eCollection 2024 Aug.
Ovarian cancer is the leading cause of death from gynecological cancer. Ovarian carcinosarcomas represent a rare, aggressive entity with a poor prognosis. Spontaneous fistulization of ovarian cancer into the digestive tract is a rare phenomenon.
A 67-year-old woman with a significant history of cardiac rhythm disorders was consulted for abdominal pain. Examination revealed tachycardia and abdominal guarding. Biology pictured elevated inflammatory markers and low prothrombin time. The abdominal computed tomography scan suggested a perforated sigmoid tumor with a peri-colonic abscess and pneumoperitoneum. She was rushed to the operating theater. Upon exploration, it was an ovarian tumor fistulized to sigmoid with peritonitis. She had an en-bloc resection with a terminal stoma. Control radiological study revealed diffuse lymph node metastasis. She was scheduled for chemotherapy.
This complication worsens the prognosis. The fistulous communication in the digestive lumen leads to the overflow of its microbial deposit. The tumor, therefore, becomes superinfected and may result in pelvic peritonitis in case of secondary rupture. On the other hand, the patient is deprived of the benefit of undergoing neoadjuvant chemotherapy, which will decrease the chances of complete macroscopic cytoreduction. Through a literature review, we aim to shed light on this rare entity in order to clarify its pathophysiological consequences and make adequate therapeutic measures.
Fistulization to the large intestine worsens the prognosis of ovarian carcinosarcomas. Surgery is mandatory and should comply with oncological requirements. Adjuvant therapy is mostly needed, although more studies should be conducted to delineate the regimen accurately.
卵巢癌是妇科癌症死亡的主要原因。卵巢癌肉瘤是一种罕见的侵袭性疾病，预后较差。卵巢癌自发瘘入消化道是一种罕见现象。
一名67岁有严重心律失常病史的女性因腹痛前来就诊。检查发现心动过速和腹部压痛。实验室检查显示炎症标志物升高，凝血酶原时间降低。腹部计算机断层扫描显示乙状结肠肿瘤穿孔伴结肠周围脓肿和气腹。她被紧急送往手术室。术中发现是一个瘘入乙状结肠的卵巢肿瘤并伴有腹膜炎。她接受了整块切除并做了末端造口。对照放射学检查显示有弥漫性淋巴结转移。她被安排进行化疗。
这种并发症会使预后恶化。消化道腔内的瘘道相通会导致其微生物沉积物溢出。因此，肿瘤会发生超级感染，如果继发破裂可能导致盆腔腹膜炎。另一方面，患者无法从新辅助化疗中获益，这将降低实现宏观完全肿瘤细胞减灭的机会。通过文献综述，我们旨在阐明这一罕见疾病，以明确其病理生理后果并采取适当的治疗措施。
瘘入大肠会使卵巢癌肉瘤的预后恶化。手术是必要的，且应符合肿瘤学要求。大多需要辅助治疗，不过还应开展更多研究以准确确定治疗方案。
