Case Study: What would you do? – Dr. Ravinder Singh
Original Case Query:
A 35 Female otherwise healthy was diagnosed with cervical cancer. She underwent TAH + BSO. Based on pathology she did not need adjuvant treatment. She developed recurrence at the vaginal cuff and then received radiation. Post-radiation, she developed intra-abdominal collections on the right and left side of the abdomen. The right one spontaneously resolved but the left persisted. A drain was inserted and cytology/cultures were sent. The cytology was negative initially and culture showed Gram Positive bacteria. Repeat cytology was done due to the lack of resolution of the collection and subsequently it showed cancer cells. Drain eventually started draining stool. What would you do? CT provided.
1. Upsize drain: radiologically or surgically
2. Refer to Surgical Oncology
3. Left Hemicolectomy with or without anastomoses
4. Loop Ileostomy
Results: download
Actual Case Outcome:
A 35 Female with cervical cancer and left sided fluid collection with drain. She underwent a loop ileostomy and clinically got better. But unfortunately, follow-up CT showed a new mesenteric mass. She is seeing oncology in hopes of getting chemo- and immunotherapy (has positive markers sensitive to immunotherapy). Hoping if she responds, she can perhaps be considered for surgical resection or remain on palliative immunotherapy.
