Presentation
Abdominal pain. History of ovarian cancer.
Patient Data
The ascending colon is dilated up to 8.6 cm, the transverse colon - up to 8.9 cm.
Suspected distal colon obstruction.
Right nephrostomy tube.
Status post TAH-BSO.
Large, mostly necrotic implant measuring 6.7 x 5.6 x 9.6 cm between the rectum and urinary bladder, arising from the vaginal stump. The implant surrounds and obstructs the distal sigmoid colon and invades the urinary bladder, thereby obstructing the distal right ureter. A much smaller implant to its left obstructs the left distal ureter.
Two implants in the left greater omentum.
Subcutaneous umbilical implant.
Left periumbilical hernia containing a short loop of small bowel.
Osteoporotic fractures of L1 and L4. L1 is a vertebra plana and displays retropulsion, exerting moderate mass effect on the thecal sac.
Properly placed right nephrostomy tube.
Case Discussion
The patient suffered from severe dementia and a host of medical problems and so her custodian opposed any surgical treatment. No biopsy was taken from the umbilical implant. It is safe to assume, though, that the implants represented recurrence of the ovarian cancer.
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