1. 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

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

3. 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

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

5. 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

6. 2017/10/15

7. 2017/10/15

8. 2017/10/15

9. 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

10. 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