Reconsideration of the timing of surgery for intestinal obstruction in patients with relapsed ovarian cancer: a case report

Reconsideration of the timing of surgery for intestinal obstruction in patients with relapsed ovarian cancer: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Reconsideration of the timing of surgery for intestinal obstruction in patients with relapsed ovarian cancer: a case report Wang Weijia, Gong Yahong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4499971/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Intestinal obstruction is common in patients with relapsed ovarian cancer. In these patients, surgical decompression is only indicated if conservative treatment has failed. However, prolonged conservative treatment may increase the risk of perioperative complications. Early surgical intervention should be indicated depending on the patient’s individual characteristics. Case presentation We report a case of a 55-year-old woman who underwent exploratory laparotomy for intestinal obstruction and relapsed ovarian cancer. The patients received fifteen days of conservative treatment before the surgery. Severe enterogenic sepsis and hyperkalaemia occurred during intestinal decompression, increasing the risk of perioperative complications. Based on the patient’s history and clinical presentation, early operation should be considered. Conclusions For patients with intestinal obstruction related to relapsed ovarian cancer, it is important to have a full understanding of the disease and choose the optimal time of surgical intervention based on the individual situation. Intestinal obstruction ovarian cancer enterogenic sepsis surgery case report Figures Figure 1 Background Ovarian cancer is the third most common gynaecologic malignancy worldwide, accounting for the highest mortality rate among these cancers [ 1 ]. Although most patients achieve complete clinical remission with cytoreductive surgery and chemotherapy, the majority will relapse within 5 years of their initial diagnosis [ 2 ]. Intestinal obstruction is a prevelent clinical issue in relapsed ovarian cancer, affecting up to 35% of cases [ 2 , 3 ]. Given the high morbidity and mortality rates associated with surgery for bowel obstruction in relapsed ovarian cancer [ 3 ], conservative therapy is usually preferred in these patients. However, intestinal obstruction and the associated increased abdominal pressure (IAP) can affect not only the function of vital organs, but also the integrity of the intestinal mucosa [ 4 ]. The most serious consequence of damage to the intestinal mucosal barrier is the translocation of intestinal bacteria and endotoxins into the bloodstream [ 4 , 5 ]. Sepsis may develop as a result, exacerbating the progression of multiple organ dysfunction syndrome. In addition, intestinal contents and damaged tissue absorbed into the bloodstream can also increase the risk of electrolyte disturbance, especially hyperkalaemia. Prolonged conservative treatment may increase the risk of perioperative complications. As such, it is critical for all physicians involved in the perioperative care of women with intestinal obstruction related to ovarian cancer to have a comprehensive understanding of the disease and the potential risk when making treatment decisions. Here, we report a case of anaesthetic management for emergency surgery for intestinal obstruction related to the recurrence of ovarian cancer. In this case, a long period of preoperative conventional therapy predisposed the patient to severe sepsis and electrolyte disturbances during the surgery. Case presentation A 55-year-old female presented to the emergency room with complains of nausea, vomiting, and inability to pass gas for the past 7 days. She received cytoreductive surgery and chemotherapy for ovarian cancer two years ago. The patient was 163 cm in height and 69 kg in weight on initial examination and the physical examination revealed an enlarged abdomen. Lab tests showed significant hypokalemia. Pelvic computed tomography (CT) scan revealed recurrence of the tumor at the junction of the vaginal stump and sigmoid colon, significant dilatation of the proximal colon, and retention of intestinal content (Fig. 1 A). Enema with glycerin and intravenous fluid therapy including potassium supplementation (7.5-12g KCl) was initiated. After seven days of conservative treatment, the hypokalemia was corrected. But the abdominal symptom was not relieved. The patient developed increasing abdominal pain, general abdominal distension, and tenderness. An emergency exploratory laparotomy was performed to relieve the obstruction. The preoperative laboratory examination showed mostly normal results. We conducted rapid sequence induction and intubation. Volatile anesthesia with sevoflurane and remifentanil infusion was administered during maintenance. The patient’s vital signs were stable throughout the anesthesia induction. The intestinal tract was extremely and extensively dilated ( Fig. 1 B). Surgeons performed a decompression at the ileum by suctioning through an incision in the intestinal wall. Shortly after the decompression, the patient experienced a rapid drop in blood pressure accompanied by tachycardia, with the lowest blood pressure recorded at 70/52 mmHg. Since there was not much blood loss and the transesophageal echocardiogram (TEE) showed hypercontractility of the left ventricle and a relative insufficiency in blood volume, we speculated that the patient developed severe septic shock. Along with volume resuscitation, the norepinephrine infusion rate was gradually increased to 0.8 µg/kg/min. Additionally, epinephrine at 0.15 µg /kg/min and pituitrin at 1 U/h were required to maintain the blood pressure and tissue perfusion. Besides, the arterial blood gas (ABG) analysis detected a severe elevation in potassium concentration to 6.0 mmol/L at one hour after the start of the surgery (Table 1 ). During the surgery, an aggressive management approach was implemented, which included intravenous furosemide, calcium gluconate, insulin, and glucose to alleviate the hyperkalemia. It took four and a half hours for the potassium concentration to finally return to 4.2 mmol/L. Table 1 Perioperative Variations in the Laboratory Parameters of the Patient Parameter time Preoperative serum electrolytes 7:00, day of surgery ABG 12:30 ABG 13:55 ABG 15:25 ABG 16:25 ABG 17:15 ABG 18:18 Serum electrolytes 7:30 postoperative day 1 WBC (×10 9 /L) 5.72 2.36 Neutrophile (%) 78.9 80.5 Sodium (mmol/L) 131 128 128 125 129 128 129 142 Potassium (mmol/L) 4.3 4.7 6.0 5.0 4.7 4.6 4.2 3.8 pH 7.437 7.447 7.398 7.353 7.277 7.244 PaO 2 (mmHg) 194 88.5 94.6 97.6 123 149 PaCO 2 (mmHg) 39.2 39.6 39.2 39.4 42.6 36.1 Bicarbonate (mmol/L) 26.3 27.2 23.9 21.9 19 15.8 Hemoglobin (g/L) 114 121 129 124 122 10.6 95 60 Base deficit (mmol/L) 2.2 3.3 -0.7 -1.2 -6.9 -11.7 Glucose (mmol/L) 7.0 7.1 7.3 9.2 9.8 10.8 12.5 10.0 Lactate (mmol/L) 1.5 1.2 1.3 1.4 2.6 4.8 Creatinine (umol/L) 48 73 PCT (ng/ml) 45 The total operating time was 6 hours, and the decompression lasted for about 4 hours. The estimated blood loss was 600 ml, and the volume of fluid infused was 8200 ml. Contaminated intestinal contents totaling 5900 ml were removed from the intestinal cavity (Fig. 1 C and D). Postoperatively, the patient received circulatory and nutritional support, as well as blood product infusions to correct anemia and coagulopathy in the intensive care unit. The blood culture revealed Enterococcus faecium. On Day 6, the patient was transferred to the ward and discharged three months later. Discussion and conclusions Ovarian cancer has the highest mortality rate among all gynecologic malignant tumors. Despite cytoreductive surgery and chemotherapy, tumor recurrence is an inevitable aspect of ovarian cancer. Bowel obstruction is a prevalent clinical issue in recurrent ovarian cancer, with an incidence ranging from 25–50% [ 6 , 7 ]. Given the high morbidity and mortality rates linked to surgery for bowel obstruction in recurrent ovarian cancer, conservative treatment has been the preferred option for these patients. However, prolonged conventional therapy may lead to the deterioration of the intestinal tract and increase the risk of severe sepsis during subsequent surgery. In this report, we shared our experience in managing a patient with intestinal obstruction from relapsed ovarian cancer. The patient received conservative treatment for 7 days but developed severe septic shock and unexpected hyperkalemia during the surgery. One of the challenges we encountered in this scenario is a newly emerging but refractory enterogenic sepsis. We observed significant hemodynamic deterioration with each attempt to explore the intestinal lumen and suction intestinal contents. Given the absence of apparent blood loss and the patient's transesophageal echocardiography findings, we hypothesized that the patient was experiencing enterogenic sepsis. The postoperative positive blood culture also supports our diagnosis. The mucosal barrier function was impaired by intra-abdominal hypertension and tumor invasion [ 6 ]. During surgery, the mucosal damage was exacerbated by the ischemia-reperfusion injury following the decompression and mechanical injury to the aspirator's head. Contaminated intestinal contents and metabolites from the necrotic tissue were absorbed into the bloodstream through the damaged intestinal membrane, leading to refractory sepsis [ 7 , 8 ]. However, during the procedure, the patient showed resistance to fluid resuscitation and norepinephrine, as the resuscitation target could not be sustained. Considering the extensive and prolonged duration of the surgery, we suspected that the patient had myocardial dysfunction due to severe sepsis. Thus, we used epinephrine and pituitrin to increase cardiac contractility and maintain peripheral vascular resistance [ 7 , 9 ]. The other problem we encountered in this case was the unexpected hyperkalemia. Patients with bowel obstruction have high intra-abdominal pressure, which impairs the integrity and function of the intestinal tract. As history shows, the patient received potassium supplementation up to 12g per day to correct her hypokalemia before the surgery. Since the intestinal mucosa was damaged due to the IAP, potassium accumulated in the small intestine as transcellular fluid, which could not be reabsorbed. After decompression, the mucosal barrier of the intestinal tract was further damaged by ischemic reperfusion and mechanical injury. Potassium that accumulated in the lumen and was released due to tissue damage was absorbed into the circulation, leading to severe hyperkalemia. History of difficulty in correcting hypokalemia should indicate the severity of the obstruction and the necessity of an early operation. In addition, intraoperative blood gas analysis is crucial for the timely detection of electrolyte imbalances in these patients. Due to postoperative anastomotic fistula and infection, it took several months for this patient to be discharged from the hospital. As mentioned above, bowel obstruction is a common clinical feature of relapsed ovarian cancer, the timing of operation is important for the patient's prognosis. The multidiscipline perioperative care team should all be familiar with the possible risks, including enterogenic sepsis, electrolyte disturbance. Early surgical treatment should be considered according to the patient's individual characteristics. Abbreviations IAP: Increased abdominal pressure; CT: Computed tomography; BP: Blood pressure; ABG : Arterial blood gas; WBC: White blood cell; PCT: procalcitonin Declarations Acknowledgements Not applicable. Authors’ contributions WWJ extracted the data and drafted manuscript. GYH provided possible differential diagnosis and revised the manuscript. Both authors read and approved the final manuscript. Funding This study was supported by research grants from Wu Jieping Medical Foundation (320.6750.18175). Availability of data and materials Not applicable. The patient’s data is only available from our hospital eletronic database which is not open to the public. Ethics approval and consent to participate This study was exempted from institutional review board approval because it was a case report, not involving personal information and safety issues. Consent for publication Written informed consent was obtained from the patient for publication of this case report. Competing interests The authors declare that they have no competing interests. References Kuroki L, Guntupalli SR. Treatment of epithelial ovarian cancer. BMJ (Clinical Research ed). 2020;371:m3773. Randall TC, Rubin SC. Management of intestinal obstruction in the patient with ovarian cancer. Oncology (Williston Park, NY). 2000;14(8). Kolomainen DF, Daponte A, Barton DPJ, et al. Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecologic Oncology. 2012;125(1):31-36. Lewis M, Benjamin ER, Demetriades D. Intra-abdominal hypertension and abdominal compartment syndrome. Current Problems In Surgery. 2021;58(11):100971. Chen Y, Liao Y, Chen X, et al. Recognition and management of hemorrhaging in combination with emerging enterogenic sepsis during a hepatectomy: a case report. BMC Anesthesiology. 2023;23(1):186. Vaishnavi C. Translocation of gut flora and its role in sepsis. Indian Journal of Medical Microbiology. 2013;31(4):334-342. Meresse Z, Medam S, Mathieu C, et al. Vasopressors to treat refractory septic shock. Minerva Anestesiologica. 2020;86(5):537-545. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine. 2021;47(11):1181-1247. Bansal M, Mehta A, Machanahalli Balakrishna A, et al. RIGHT VENTRICULAR DYSFUNCTION IN SEPSIS: AN UPDATED NARRATIVE REVIEW. Shock (Augusta, Ga). 2023;59(6):829-837. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4499971","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":312128620,"identity":"1a27350c-2986-4073-82e8-a9e1c7d0dacd","order_by":0,"name":"Wang Weijia","email":"","orcid":"","institution":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Weijia","suffix":""},{"id":312128621,"identity":"372c2f7f-25a1-44e3-9374-c81a4b35254e","order_by":1,"name":"Gong Yahong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIie3PMQrCMBTG8ZZApqdZGxT0CIGCIhS9Skqhk+AVHhQ8Q3qRzq8IjroW6tIbJBcQnZyfm2B+0xu+//CSJIp+USaIwrMApZCdyHJysl5qR+wE8hzkpTBomYUZcaMd3MEklPpw5CQPqjOfjbAVKHTbcZLBXrUzI+yQpJjxkvK8AHsDQ5adVCIHoi8SPdTp1GIF2vUN75f5cPIUcH9Qqul94CRr+pwpMvZvK+YuiqLon70AsHU7CIdVvKMAAAAASUVORK5CYII=","orcid":"","institution":"Peking Union Medical College Hospital, Chinese Academy of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Gong","middleName":"","lastName":"Yahong","suffix":""}],"badges":[],"createdAt":"2024-05-30 03:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4499971/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4499971/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58384731,"identity":"6cdd5507-7777-4ec4-9f77-2af18c5d6e3c","added_by":"auto","created_at":"2024-06-14 18:36:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111063,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative images showing: (A) severely distended intestine in erect X-ray of the abdomen (B) extensive bowel dilation ; (C) contaminated intestinal contents in the suction; (D) the ileum specimen\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4499971/v1/1d2ddfb6b4ce0d0ca780b4d5.jpg"},{"id":65437524,"identity":"71f15098-24bd-40c2-a34f-da3834617e5a","added_by":"auto","created_at":"2024-09-27 12:15:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":471493,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4499971/v1/120edb4f-134d-4aba-bff6-73465b160134.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reconsideration of the timing of surgery for intestinal obstruction in patients with relapsed ovarian cancer: a case report","fulltext":[{"header":"Background","content":"\u003cp\u003eOvarian cancer is the third most common gynaecologic malignancy worldwide, accounting for the highest mortality rate among these cancers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although most patients achieve complete clinical remission with cytoreductive surgery and chemotherapy, the majority will relapse within 5 years of their initial diagnosis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Intestinal obstruction is a prevelent clinical issue in relapsed ovarian cancer, affecting up to 35% of cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the high morbidity and mortality rates associated with surgery for bowel obstruction in relapsed ovarian cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], conservative therapy is usually preferred in these patients. However, intestinal obstruction and the associated increased abdominal pressure (IAP) can affect not only the function of vital organs, but also the integrity of the intestinal mucosa [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The most serious consequence of damage to the intestinal mucosal barrier is the translocation of intestinal bacteria and endotoxins into the bloodstream [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Sepsis may develop as a result, exacerbating the progression of multiple organ dysfunction syndrome. In addition, intestinal contents and damaged tissue absorbed into the bloodstream can also increase the risk of electrolyte disturbance, especially hyperkalaemia. Prolonged conservative treatment may increase the risk of perioperative complications. As such, it is critical for all physicians involved in the perioperative care of women with intestinal obstruction related to ovarian cancer to have a comprehensive understanding of the disease and the potential risk when making treatment decisions.\u003c/p\u003e \u003cp\u003eHere, we report a case of anaesthetic management for emergency surgery for intestinal obstruction related to the recurrence of ovarian cancer. In this case, a long period of preoperative conventional therapy predisposed the patient to severe sepsis and electrolyte disturbances during the surgery.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 55-year-old female presented to the emergency room with complains of nausea, vomiting, and inability to pass gas for the past 7 days. She received cytoreductive surgery and chemotherapy for ovarian cancer two years ago. The patient was 163 cm in height and 69 kg in weight on initial examination and the physical examination revealed an enlarged abdomen. Lab tests showed significant hypokalemia. Pelvic computed tomography (CT) scan revealed recurrence of the tumor at the junction of the vaginal stump and sigmoid colon, significant dilatation of the proximal colon, and retention of intestinal content (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Enema with glycerin and intravenous fluid therapy including potassium supplementation (7.5-12g KCl) was initiated. After seven days of conservative treatment, the hypokalemia was corrected. But the abdominal symptom was not relieved. The patient developed increasing abdominal pain, general abdominal distension, and tenderness. An emergency exploratory laparotomy was performed to relieve the obstruction. The preoperative laboratory examination showed mostly normal results.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe conducted rapid sequence induction and intubation. Volatile anesthesia with sevoflurane and remifentanil infusion was administered during maintenance. The patient\u0026rsquo;s vital signs were stable throughout the anesthesia induction. The intestinal tract was extremely and extensively dilated ( Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Surgeons performed a decompression at the ileum by suctioning through an incision in the intestinal wall. Shortly after the decompression, the patient experienced a rapid drop in blood pressure accompanied by tachycardia, with the lowest blood pressure recorded at 70/52 mmHg. Since there was not much blood loss and the transesophageal echocardiogram (TEE) showed hypercontractility of the left ventricle and a relative insufficiency in blood volume, we speculated that the patient developed severe septic shock. Along with volume resuscitation, the norepinephrine infusion rate was gradually increased to 0.8 \u0026micro;g/kg/min. Additionally, epinephrine at 0.15 \u0026micro;g /kg/min and pituitrin at 1 U/h were required to maintain the blood pressure and tissue perfusion.\u003c/p\u003e \u003cp\u003eBesides, the arterial blood gas (ABG) analysis detected a severe elevation in potassium concentration to 6.0 mmol/L at one hour after the start of the surgery (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). During the surgery, an aggressive management approach was implemented, which included intravenous furosemide, calcium gluconate, insulin, and glucose to alleviate the hyperkalemia. It took four and a half hours for the potassium concentration to finally return to 4.2 mmol/L.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative Variations in the Laboratory Parameters of the Patient\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv 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\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eABG\u003c/p\u003e \u003cp\u003e16:25\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eABG\u003c/p\u003e \u003cp\u003e17:15\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eABG\u003c/p\u003e \u003cp\u003e18:18\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSerum electrolytes 7:30 postoperative day 1\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophile (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e80.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e97.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBicarbonate (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBase deficit (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactate (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (umol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCT (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe total operating time was 6 hours, and the decompression lasted for about 4 hours. The estimated blood loss was 600 ml, and the volume of fluid infused was 8200 ml. Contaminated intestinal contents totaling 5900 ml were removed from the intestinal cavity (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC and D).\u003c/p\u003e \u003cp\u003ePostoperatively, the patient received circulatory and nutritional support, as well as blood product infusions to correct anemia and coagulopathy in the intensive care unit. The blood culture revealed Enterococcus faecium. On Day 6, the patient was transferred to the ward and discharged three months later.\u003c/p\u003e"},{"header":"Discussion and conclusions","content":"\u003cp\u003eOvarian cancer has the highest mortality rate among all gynecologic malignant tumors. Despite cytoreductive surgery and chemotherapy, tumor recurrence is an inevitable aspect of ovarian cancer. Bowel obstruction is a prevalent clinical issue in recurrent ovarian cancer, with an incidence ranging from 25\u0026ndash;50% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Given the high morbidity and mortality rates linked to surgery for bowel obstruction in recurrent ovarian cancer, conservative treatment has been the preferred option for these patients. However, prolonged conventional therapy may lead to the deterioration of the intestinal tract and increase the risk of severe sepsis during subsequent surgery. In this report, we shared our experience in managing a patient with intestinal obstruction from relapsed ovarian cancer. The patient received conservative treatment for 7 days but developed severe septic shock and unexpected hyperkalemia during the surgery.\u003c/p\u003e \u003cp\u003eOne of the challenges we encountered in this scenario is a newly emerging but refractory enterogenic sepsis. We observed significant hemodynamic deterioration with each attempt to explore the intestinal lumen and suction intestinal contents. Given the absence of apparent blood loss and the patient's transesophageal echocardiography findings, we hypothesized that the patient was experiencing enterogenic sepsis. The postoperative positive blood culture also supports our diagnosis. The mucosal barrier function was impaired by intra-abdominal hypertension and tumor invasion [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. During surgery, the mucosal damage was exacerbated by the ischemia-reperfusion injury following the decompression and mechanical injury to the aspirator's head. Contaminated intestinal contents and metabolites from the necrotic tissue were absorbed into the bloodstream through the damaged intestinal membrane, leading to refractory sepsis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, during the procedure, the patient showed resistance to fluid resuscitation and norepinephrine, as the resuscitation target could not be sustained. Considering the extensive and prolonged duration of the surgery, we suspected that the patient had myocardial dysfunction due to severe sepsis. Thus, we used epinephrine and pituitrin to increase cardiac contractility and maintain peripheral vascular resistance [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe other problem we encountered in this case was the unexpected hyperkalemia. Patients with bowel obstruction have high intra-abdominal pressure, which impairs the integrity and function of the intestinal tract. As history shows, the patient received potassium supplementation up to 12g per day to correct her hypokalemia before the surgery. Since the intestinal mucosa was damaged due to the IAP, potassium accumulated in the small intestine as transcellular fluid, which could not be reabsorbed. After decompression, the mucosal barrier of the intestinal tract was further damaged by ischemic reperfusion and mechanical injury. Potassium that accumulated in the lumen and was released due to tissue damage was absorbed into the circulation, leading to severe hyperkalemia. History of difficulty in correcting hypokalemia should indicate the severity of the obstruction and the necessity of an early operation. In addition, intraoperative blood gas analysis is crucial for the timely detection of electrolyte imbalances in these patients. Due to postoperative anastomotic fistula and infection, it took several months for this patient to be discharged from the hospital.\u003c/p\u003e \u003cp\u003eAs mentioned above, bowel obstruction is a common clinical feature of relapsed ovarian cancer, the timing of operation is important for the patient's prognosis. The multidiscipline perioperative care team should all be familiar with the possible risks, including enterogenic sepsis, electrolyte disturbance. Early surgical treatment should be considered according to the patient's individual characteristics.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIAP: Increased abdominal pressure; CT: Computed tomography; BP: Blood pressure; ABG : Arterial blood gas; WBC: White blood cell; PCT: procalcitonin\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWWJ extracted the data and drafted manuscript. GYH provided possible differential diagnosis and revised the manuscript. Both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by research grants from Wu Jieping Medical Foundation (320.6750.18175).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. The patient’s data is only available from our hospital eletronic database which is not open to the public.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was exempted from institutional review board approval because it was a case report, not involving personal information and safety issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKuroki L, Guntupalli SR. Treatment of epithelial ovarian cancer. BMJ (Clinical Research ed). 2020;371:m3773.\u003c/li\u003e\n\u003cli\u003eRandall TC, Rubin SC. Management of intestinal obstruction in the patient with ovarian cancer. Oncology (Williston Park, NY). 2000;14(8).\u003c/li\u003e\n\u003cli\u003eKolomainen DF, Daponte A, Barton DPJ, et al. Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecologic Oncology. 2012;125(1):31-36.\u003c/li\u003e\n\u003cli\u003eLewis M, Benjamin ER, Demetriades D. Intra-abdominal hypertension and abdominal compartment syndrome. Current Problems In Surgery. 2021;58(11):100971.\u003c/li\u003e\n\u003cli\u003eChen Y, Liao Y, Chen X, et al. Recognition and management of hemorrhaging in combination with emerging enterogenic sepsis during a hepatectomy: a case report. BMC Anesthesiology. 2023;23(1):186.\u003c/li\u003e\n\u003cli\u003eVaishnavi C. Translocation of gut flora and its role in sepsis. Indian Journal of Medical Microbiology. 2013;31(4):334-342.\u003c/li\u003e\n\u003cli\u003eMeresse Z, Medam S, Mathieu C, et al. Vasopressors to treat refractory septic shock. Minerva Anestesiologica. 2020;86(5):537-545.\u003c/li\u003e\n\u003cli\u003eEvans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine. 2021;47(11):1181-1247.\u003c/li\u003e\n\u003cli\u003eBansal M, Mehta A, Machanahalli Balakrishna A, et al. RIGHT VENTRICULAR DYSFUNCTION IN SEPSIS: AN UPDATED NARRATIVE REVIEW. Shock (Augusta, Ga). 2023;59(6):829-837.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intestinal obstruction, ovarian cancer, enterogenic sepsis, surgery, case report","lastPublishedDoi":"10.21203/rs.3.rs-4499971/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4499971/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIntestinal obstruction is common in patients with relapsed ovarian cancer. In these patients, surgical decompression is only indicated if conservative treatment has failed. However, prolonged conservative treatment may increase the risk of perioperative complications. Early surgical intervention should be indicated depending on the patient’s individual characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe report a case of a 55-year-old woman who underwent exploratory laparotomy for intestinal obstruction and relapsed ovarian cancer. The patients received fifteen days of conservative treatment before the surgery. Severe enterogenic sepsis and hyperkalaemia occurred during intestinal decompression, increasing the risk of perioperative complications. Based on the patient’s history and clinical presentation, early operation should be considered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor patients with intestinal obstruction related to relapsed ovarian cancer, it is important to have a full understanding of the disease and choose the optimal time of surgical intervention based on the individual situation.\u003c/p\u003e","manuscriptTitle":"Reconsideration of the timing of surgery for intestinal obstruction in patients with relapsed ovarian cancer: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-14 18:36:44","doi":"10.21203/rs.3.rs-4499971/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85b64406-e915-4568-919c-169202b51ad0","owner":[],"postedDate":"June 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-27T12:11:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-14 18:36:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4499971","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4499971","identity":"rs-4499971","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}