EC Clinical and Medical Case Reports

Tumor-bowel fistula (TBF) is a rare but serious complication of abdominal and pelvic malignancies, including endometrial cancer, and may, in rare instances, result in gastrointestinal obstruction. We present a case of a 65-year-old female with endometrial adenocarcinoma, initially treated with hysterectomy, bilateral salpingo-oophorectomy, and adjuvant therapy, who developed a peritoneal recurrence in July 2022. In January 2023, she presented with persistent vomiting. Contrast-enhanced computed tomography (CT) showed fistulous communication between the peritoneal mass and the terminal ileal loop, complicated by small bowel obstruction. The patient underwent emergency resection of the peritoneal mass and involved bowel. Postoperatively, she developed a surgical site infection and ultimately succumbed to septic shock. This case highlights the importance of CT in early TBF diagnosis and the management challenges associated with poor prognostic outcomes.

 Keywords: Endometrial Carcinoma; Peritoneal Recurrence; Tumor-Bowel Fistula; Small Bowel Obstruction; CT Imaging

1. Tirumani SH., et al. “Tumor-bowel fistula: what radiologists should know”. Abdominal Imaging5 (2013): 1014-1023.
2. Kurra V., et al. “Typical and atypical metastatic sites of recurrent endometrial carcinoma”. Cancer Imaging1 (2013): 113-122.
3. Lin MY., et al. “Role of imaging in the routine management of endometrial cancer”. International Journal of Gynecology and Obstetrics2 (2018): 109-117.
4. Sohaib SA., et al. “Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis”. Clinical Radiology1 (2007): 28-34.
5. Pereira ROL., et al. “Tumour-bowel fistula as a possible complication of pazopanib therapy in retroperitoneal leiomyosarcoma”. BMJ Case Reports 11 (2019): e230727.
6. Paulson EK and Thompson WM. “Review of small-bowel obstruction: the diagnosis and when to worry”. Radiology 2 (2015): 332-342.
7. Tirumani SH., et al. “Multidetector-row CT of tumour-bowel fistula: Experience at a tertiary cancer centre”. Clinical Radiology2 (2014): e100-e107.
8. Katabathina VS., et al. “Imaging of oncologic emergencies: what every radiologist should know”. Radiographics 6 (2013): 1533-1553.
9. Jankowska-Lombarska M., et al. “Tumor-bowel fistula as a rare form of recurrent ovarian cancer-imaging and treatment: preliminary report”. Current Oncology1 (2022): 506-517.
10. Kawakubo N., et al. “Surgical management of intertumor abscesses caused by fistulous communications with the intestine: rare complication in pediatric malignant tumor: 2 case reports”. International Journal of Surgery Oncology 6 (2020): e98.