There are less than 100 cases described in the literature, so this study could help to clarify the behavior of this neoplasm. Additionally, the successful management of severe evisceration that complicated the postoperative stay of the patient is analyzed. The incidence of this major postoperative complication is reported between 0.29 www.selleckchem.com/products/lapatinib.html �C 2.3% (4,5). Evisceration is defined as the acute, complete disruption of the musculofascial layers, which results in herniation of the abdominal contents, usually the small bowel and omentum. Emergency surgical intervention is needed. This complication is potentially lethal and carries a mortality rate of approximately 25% (4). Cardiorespiratory failure accounts for 50% of deaths, while peritonitis has been reported as the cause in 15% of the cases (6).
Risk factors associated with death from acute wound failure are mechanical ventilation, female sex and advanced age. There are four main causes of wound evisceration: suture tearing through the fascia, knot failure, suture failure, and extrusion of abdominal contents between sutures placed too far apart. The most common and important factor is suture tearing through the fascia. Tissue healing is adversely affected by several factors, such as obesity, diabetes, renal failure, anemia, malignancy, postoperative increased intra-abdominal pressure, wound infection, glycocorticoids, antineoplastic agents or radiation. However, careful review would suggest that at least 50% of the cases are due to technical error (6).
Case report The patient, a nulliparous post-menopausal 76-years old Greek woman, was admitted to our Department because of abnormal findings during ultrasound examination of the pelvic organs. She had a history of hypertension and anxiety disorder under medical therapy. Her past surgical history was unremarkable. She was presented asymptomatic, but pelvic examination revealed bilateral non-motile ovarian masses and a second degree rectocele. Transvaginal ultrasound examination confirmed the diagnosis of bilateral ovarian masses, with a maximum diameter of 9 cm for the right and 7 cm for the left ovarian tumor. Their ultrasound characteristics were suggestive of cystic masses but with solid components. The ultrasound examination revealed also micropapillary elements into the tumor of the right ovary. The uterus was found normal with an endometrium thickness of 3 mm.
Cytological examination of cervical/vaginal smear (Papanikolaou examination) was negative for presence of malignant cells. The levels of serum cancer antigen CA-125 were elevated at 60.7 U/ml (normal ranges 0 �C 35 U/ml), while the others serum cancer antigen markers were into normal ranges. The appearance of the tumors at the computed tomography Entinostat (CT) examination was similar with that of the ultrasound examination. The possibility of ovarian malignant disease was high according to the results of CT.