P0296 - Hematochezia as Initial Presentation for Metastatic Ovarian Adenocarcinoma: A Case Report

Dakota Bigham, MD¹, Laura Rosenkranz, MD², James Alvarez, MD¹, Mason Adams, MD¹, Hamza Khan, MD³, Jonathan Selzman, DO², Benjamin Heriford, DO², Umar Siddiqui, DO¹, Leen Azeez, BA^1
1University of Texas Health Science Center-San Antonio, San Antonio, TX; ²University of Texas Health Science Center at San Antonio, San Antonio, TX; ³UT Health San Antonio, San Antonio, TX

Introduction: Colonic metastasis is a rare occurrence, representing only 0.1-1.0% of all colorectal tumors. Colorectal metastasis originating from ovarian cancer represents 6% of colorectal cancer cases in women. We present the case of an obstructive sigmoid colon mass of ovarian origin.

Case Description/Methods: A 90-year-old woman with a history of recent vaginal bleeding presented with 4 months of hematochezia and narrow caliber stools. The patient had not undergone a colonoscopy in over 10 years. Following her episode of vaginal bleeding, imaging revealed a cervical mass with adjacent rectal wall thickening. Due to her low risk for cervical cancer based on no sexual history, nulliparity, and no HPV exposure, GI was consulted to evaluate the hematochezia. A continuous, nearly circumferential, ulcerated, bleeding, obstructive mass was found in the sigmoid colon. A pediatric colonoscope could not traverse the obstruction. Biopsies were taken, and the findings suggested a high-grade serous adenocarcinoma of ovarian origin, with subsequent imaging reports confirming the presence of metastasis to the lungs, rectal mucosa, and omentum.

Discussion: Metastatic dissemination to the colon is a rare incident, often masquerading as a primary tumor. Presentation is usually late in the course with the rectosigmoid and descending colon being the most common sites for ovarian carcinoma metastasis. Prompt investigation is imperative to detect or exclude primary gastrointestinal malignancies, while also considering alternative sources of the disease, as was the scenario in this specific patient.


Disclosures:


Dakota Bigham, MD¹, Laura Rosenkranz, MD², James Alvarez, MD¹, Mason Adams, MD¹, Hamza Khan, MD³, Jonathan Selzman, DO², Benjamin Heriford, DO², Umar Siddiqui, DO¹, Leen Azeez, BA¹. P0296 - Hematochezia as Initial Presentation for Metastatic Ovarian Adenocarcinoma: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.