Successful Management of Upper Gastrointestinal Obstruction With Primary Advanced Ovarian Cancer

Abstract

Background/aim: Upper gastrointestinal obstruction is an extremely rare complication of primary ovarian cancer. We present a case of primary advanced ovarian cancer with gastroduodenal obstruction successfully managed with neoadjuvant chemotherapy (NAC) and conservative treatment.

Case report: A 60-year-old woman was referred to our hospital for advanced ovarian cancer with upper gastrointestinal obstruction. Computed tomography and endoscopy revealed severe duodenal obstruction caused by dissemination. NAC was initiated with conservative management using a nasogastric tube and total parenteral nutrition (TPN). She was able to eat and TPN was stopped after three months. Complete resection was achieved with interval debulking surgery (IDS) not involving pancreatoduodenectomy, which would have been necessary for primary debulking surgery. There were no serious postoperative complications.

Conclusion: NAC with conservative management can improve upper gastrointestinal obstruction in patients with primary advanced ovarian cancer. Furthermore, IDS is expected to allow complete resection, avoiding highly invasive surgeries.

Keywords: Upper gastrointestinal tract; cytoreductive surgery; neoadjuvant chemotherapy; ovarian cancer; pancreaticoduodenectomy.

Figure 1. Contrast-enhanced computed tomography (CT) image before treatment revealing dissemination (red arrow) causing obstruction at the third portion of the duodenum (yellow arrow) and the omental cake (green arrow) with adhesions extending to the transverse colon and greater curvature of the stomach (A). CT image after neoadjuvant chemotherapy revealing reduction of the omental cake and improvement of the duodenal obstruction (white arrow) (B).

Figure 2. Upper gastrointestinal endoscopy image revealing severe stenosis (red arrow) near the inferior duodenal angulus of the third portion of the duodenum (A). Endoscopy image demonstrating stenosis of the duodenum caused by external compression but no neoplastic lesions in the gastrointestinal mucosa (B).

Figure 3. Invasion of the greater curvature of the stomach and transverse colon (blue arrow) by the omental cake (green arrow) during exploratory laparotomy. The tumor was strongly adhered to the duodenum on the dorsal side (A). The shrunken omental nodule (2.5 cm; black arrow) was partially adhered to the greater curvature of the stomach and transverse colon (blue arrow) at the time of interval debulking surgery. Both the duodenum (white arrow) and pancreatic head (purple arrow) were exfoliated from the tumor (B).