Malignant Bowel Obstruction Secondary to Advanced Serous Ovarian Carcinoma: Impact of Late Presentation and Delayed Postoperative Chemotherapy - A Case Report

Abstract

Background: High-grade serous ovarian carcinoma (HGSOC) is the most common and aggressive sub-type of epithelial ovarian cancer, often diagnosed at advanced stages due to non-specific symptoms. Despite advances in surgical and chemotherapeutic strategies, the prognosis remains poor, particularly in late-stage disease. Malignant bowel obstruction (MBO) is a severe complication in advanced ovarian cancer, contributing to significant morbidity and mortality. Case Presentation: A 51-year-old nulliparous woman presented with a three-month history of progressive weight loss, abdominal distension, and anorexia. Imaging revealed a 7.8 × 3.9 x 8.0 cm left ovarian mass with liver parenchyma metastases and ascites. Histopathological examination confirmed stage IVB high-grade serous ovarian carcinoma. The patient underwent staging laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolic omentectomy (optimal cytoreduction). Postoperatively, there was a delay in the commencement of chemotherapy for six weeks due to patient non-compliance, despite adequate counseling on the need for adjuvant chemotherapy. After receiving one cycle of chemotherapy, she defaulted and later presented with malignant bowel obstruction and renal failure. Despite conservative management and dialysis, she died on day 8 of readmission. Conclusion: Timely postoperative follow-up and early initiation of chemotherapy are critical in advanced ovarian cancer to prevent disease progression and complications such as malignant bowel obstruction. Delays in treatment due to non-compliance significantly worsen clinical outcomes, exacerbate health disparities, and diminish the effectiveness of medical and surgical interventions, particularly in low-resource settings, as demonstrated in this case. This underscores the importance of patient adherence to treatment protocols and the need for close surveillance in managing advanced ovarian cancer.