A 50-year-old woman was admitted to the department because of intensifying abdominal pain with slight fever which started about one month before admission though the degree of he pain was slight. Abdominal simple x-ray film in the upright position visualized a cystic tumor in the lower abdomen and air fluid level in the tumor. Abdominal CT scan revealed a similar picture. Colonofiberscopy revealed a Borrmann type 2 tumor at the recto-sigmoid colon. Barium enema study showed leakage of contrast matrial from the vicinity of the tumor, and the inside of the cystic tumor which was revealed by the abdominal simple x-ray film and CT scan. Further the ascending colon was visualized through the fistula. Fistula formation of the ovarian cyst and ascending colon due to the cancer of the recto-sigmoid colon was diagnosed and the patient was operated on. Operative procedures included ‘en-bloc’ resection of the rectum, ovarian cyst, and ileocecal region which strongly adhered each other and simultaneus sutures between the ileum and ascending colon and between the descending colon and rectum. Postoperative course was uneventful.
This is an extremely rare case in which cancer of the recto-sigmoid colon perforated to the overian cyst to form a fistula in the midst of the adhesions which further perforated to the ascending colon.