title: Accidentally delayed diagnosis of ruptured ovarian carcinoma in a young woman: a care report.
abstract: Ovarian carcinoma commonly occurs in postmenopausal women and often presents with an insidious course. Acute abdomen is rarely an initial symptom. When these patients present with abdominal discomfort, the disease has already spread throughout the peritoneal cavity. We present a case of mucinous cystadenocarcinoma in a young woman who presented with acute abdomen and intra-abdominal bleeding. This 24-year-old woman was previously diagnosed with a ruptured left ovarian cystic tumor at a primary clinic. She underwent emergency exploratory laparotomy, followed by unilateral salpingo-oophorectomy at the clinic. No thorough examination of the peritoneal cavity was done during surgery. The diagnosis of mucinous cystadenocarcinoma was accidentally over-looked until one month later when she returned for routine follow-up. Upon referral to our clinic, the patient underwent a repeat laparotomy. The surgicopathologic diagnosis was intraperitoneal carcinomatosis stage IIIC that could not be excised completely, even though rigorous staging surgery including washing cytology, total abdominal hysterectomy, salpingo-oophorectomy, retroperitoneal lymphadenectomy, appendectomy, infracolic omentectomy and excision of any suspicious and removable lesions were performed. This case alerts us to consider the possibility of ovarian malignancy when a young woman presents with an acute abdomen secondary to ruptured ovarian cystic tumor and intraperitoneal hemorrhage. Careful preoperative preparation and thorough intrasurgical examination of the peritoneal cavity along with a prompt pathologic diagnosis of suspicious lesions will prevent missed diagnoses.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan, ROC.
authors.forename: P H
authors.initials: PH
authors.lastname: Wang
authors.forename: K C
authors.initials: KC
authors.lastname: Chao
authors.forename: M S
authors.initials: MS
authors.lastname: Yen
authors.forename: H T
authors.initials: HT
authors.lastname: Ng
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D012422:Rupture, Spontaneous