Only diverticulosis http://www.selleckchem.com/products/PD-0332991.html of the sigmoid colon and no invasion was found during colonoscopy. After chest X-ray, mammography, cardiological and appropriate blood preoperative examinations the patient underwent exploratory laparotomy in order to exclude the possibility of ovarian cancer. Under general and epidural anesthesia, a midline abdominal incision was made. The macroscopic appearance of the peritoneum, omentum and the organs of the upper abdomen was negative for disease. Para-aortic lymph nodes were not palpable. Peritoneal washings were sent for cytological examination. Total hysterectomy with bilateral salpingo-oophorectomy was performed. The gross appearance of the tumor of the right ovary during frozen section was suggestive of malignancy.

Omentectomy, bilateral pelvic lymphadenectomy and multiple biopsies from the peritoneum followed. No intraoperative complications were noted and the patient did not received blood transfusion. The surgical wound was closed via mass closure technique (all layers incorporated with stitch, executed by using a continuous PDS loop). The surgical time was about 160 minutes and the patient recovered normal. The cytological examination of the peritoneal washings revealed groups of small to medium adenocytes with papillary formation and low degree of nuclear atypia, characteristics suspicious for malignancy. Final histological examination showed bilateral ovarian borderline micropapillary serous tumors (maximum diameter 9.5 cm for the right and 7.5 cm for the left ovary, without stromal invasion) with superficial, non-invasive implants to the uterus and the omentum.

The 26 totally removed pelvic lymph nodes (9 from the right and 17 from the left side), were found negative for malignant disease. According to the FIGO staging system the case was staged as IIIA with non-invasive peritoneal implants. Unfortunately, the patient underwent a second operation at the fifth postoperative day because of acute wound failure. Surgical intervention on an emergency basis was performed after recognition of a serosanguinous discharge from the wound. An injury of the small bowel with a length of 2 cm, in contact with the suture of the fascia, which was not disrupted, was found. This part of the small bowel was removed and an end to end anastomosis of the small bowel was performed. All the necrotic tissue of the wound and the old suture were removed.

The surgical wound was closed without tension via interrupted technique using 1�C0 monofilament delayed absorbable suture material. The patient recovered well, after a short postoperative stay in the intensive care unit were hypokalemia and hypertension as well as respiratory problems were successfully managed. No adjuvant therapy was decided and the patient GSK-3 remains well, without signs of recurrence eight months after initial surgery.