Residency Program - Case of the Month

Clinical History:

The decedent is a 57 year old female with a history of papillary serous ovarian cancer (stage IIIc) who underwent a radical hysterectomy and debulking of her primary tumor followed by six cycles of intraperitoneal chemotherapy.  She eventually developed a recurrence in her left pelvis and underwent a second debulking with a left para-aortic lymphadenectomy and resection of her rectosigmoid colon with anastomosis.  The tumor did not respond to chemotherapy and thus she received palliative radiation.

The decedent presented to the ED with acute onset of bright red blood per rectum. She was hypotensive and had a hemoglobin of 8.5.  Blood product transfusion and fluid resuscitation produced a marginal response. The decedent went into both a pulseless ventricular tachycardia and ventricular fibrillation where she received cardiac defibrillation several times. During the code, there were copious amounts of bright red blood coming from her rectum. A colonoscopy was performed and an arterial bleed was noted at 25cm with an overlying clot. Multiple clips were placed without achieving hemostasis. The decedent soon after was pronounced dead.

Autopsy Images:

Microscopic photographs:

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