Fast diagnosis and successful management of stress-induced ulcer with hemorrhagic shock following staging surgery for ovarian cancer: a case report.

BACKGROUND

Ovarian cancer (OC) is a common gynecologic malignancy, and postoperative management is crucial. Stress ulcers (SU), also known as stress-related mucosal disease, are a manifestation of gastrointestinal dysfunction in the body under severe trauma, critical illness, or significant psychological distress. The occurrence of SU after surgery is rare. Here we report a case of a 56-year-old female patient who developed a SU complicated by hemorrhagic shock after undergoing OC staging surgery. We quickly recognized the patient's condition and provided timely, standardized treatment, ultimately achieving a good prognosis.

CASE DESCRIPTION: The patient was diagnosed with pelvic malignancy via laparoscopic biopsy at our hospital. Prior to the comprehensive staging surgery for OC, the patient had received three cycles of intravenous paclitaxel combined with carboplatin neoadjuvant chemotherapy, and subsequently underwent OC staging surgery at our hospital. Postoperatively, due to significant intraoperative adhesions and bowel involvement, the patient was kept NPO (nothing by mouth) and received parenteral nutrition, antibiotic prophylaxis for infection, lower limb pneumatic therapy, and subcutaneous low molecular weight heparin (LMWH) 4,000 IU (once daily) to prevent deep vein thrombosis. On the eleventh postoperative day, the patient suddenly experienced dizziness, blurred vision, profuse sweating, and cold, clammy extremities. This was accompanied by a drop in blood pressure and a decrease in hemoglobin to 91 g/L, down from 124 g/L on postoperative day nine. The team quickly assessed the patient's condition, suspecting acute upper gastrointestinal bleeding with hemorrhagic shock, and promptly administered intravenous fluid resuscitation and acid suppression therapy. The patient's symptoms were alleviated. On the twelfth postoperative day, the patient reported no special discomfort, no bleeding, and stable vital signs. Ultimately, the patient was discharged smoothly on the twentieth postoperative day.

CONCLUSIONS

Patients with OC are prone to developing SU due to surgical trauma, stress response, and prolonged fasting. Although it is rare, early identification and proper management are of great importance.