Management of colo-adnexal fistula in serous adenocarcinoma of the ovary: a case report

Abstract

Ovarian cancer is the leading cause of death from gynecological cancer. Fistulization of ovarian cancer into digestive tract with a fistula tract is a rare phenomenon. This complication worsens the prognosis, the fistulous communication in the digestive lumen leads to the leakage of its contents. 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 a complete macroscopic cytoreduction. This case presents a 53-year-old patient operated on for a presumed ovarian abscess. Upon exploration, an ovarian tumor fistulized into the sigmoid was discovered. The treatment consisted of sigmoidectomy, creation of an end-loop colostomy, total hysterectomy, bilateral oopohorectomy, peritonectomy of 2 pelvic parietal nodules, infra-gastric omentectomy and lombo-aortic curage. The current case highlighted the encountered difficulty on diagnostic and therapeutic levels: the ovarian tumor was misdiagnosed as an abscess and the need of extensive extirpative surgery to comply with “oncological surgery of the ovary” in a hostile environment. Through a literature review, we aim to sensitize the medical community of this rare entity in order to clarify its pathophysiological consequences and make the adequate therapeutic measures.