A rare case of acute abdomen secondary to rupture of a Krukenberg tumor with intra- abdominal hemorrhage 三軍總醫院外科部大腸直腸外科 浦大維 糠榮誠 1

General data Gender: female Age: 62 years old Non-smoker Multiparous woman 2

Health examination colonoscopy: a tumor at the proximal sigmoid colon. Abdominal CT: sigmoid colonic adenocarcinoma and multiple metastases in the liver. 2012/12 Laparoscopic AR pT3N1M1, KRAS wild-type Cycles of chemotherapy with FOLFIRI and cetuximab 3 3

Pre-operation CEA: 1738.09 ng/ml 2013/03, the postoperative CEA: 183.48 ng/ml 2016/04, CEA level was increased to 1001.69 ng/ml 2017/10/15

Severe and progressively intense pain in the lower abdomen Body temperature: normal BP: 80/60 mmHg, PR: 100 beats/min. Abdominal examination: muscle guarding, and rigidity WBC: 9.9 × 103/μl, N/L: 85.9/5.9%. Hb: 8 g/dl and was noted to decrease by 1.6 g/dl over a 2-h period in the emergency department. CRP level was < 0.03 mg/dl. 2016/04 5 5

2017/10/15

2017/10/15

2017/10/15

Exploratory laparotomy with salpingo-oophorectomy. (A) A large ruptured right ovarian tumor was found (14.0 × 9.5 × 4.5 cm) (B) a smaller left ovarian tumor (8.5 × 6.5 × 5.0 cm). Exploratory laparotomy with salpingo-oophorectomy. 2500 ml of blood and ascites and a ruptured right ovarian mass with active intra-abdominal hemorrhage were found. 2017/10/15

Conclusion: Rupture of a Krukenberg tumor with intra-abdominal hemorrhage or ovarian torsion may present as acute abdomen. Despite its rarity, this diagnosis should be considered in women presenting with acute abdomen and ovarian tumors and hemoperitoneum. 2017/10/15