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Global Translational Medicine Late abscess complication endometrial cancer

to the patient’s symptoms and take them seriously, and our
agility to react to changing circumstances and reinvestigate
new presentations was crucial to eventually determining the
correct diagnosis. Ultimately, this patient received a dose of
chemotherapy that was not indicated; however, we could
no longer delay taking action. For a future presentation,
we would consider starting empiric antibiotic therapy for a
pelvic mass and leukocytosis.

4. Conclusion
This was a challenging case of a post-radiation bowel
microperforation and pelvic abscess in a patient with
grade 2 stage 1B endometrial carcinoma treated with
surgery and EBRT. Diagnosis was challenging due to non-
Figure 1. Abdomen/pelvis computed tomography showing a mass along specific symptoms and inability to obtain a biopsy specimen
the left pelvic sidewall, which is partially encasing and narrowing the
left external iliac artery and inseparable from the left psoas, iliacus, and for culture and pathology due to comorbid obesity,
obturator internus muscles. anxiety, pain and respiratory disease. Patients with stage
1 endometrial carcinoma who receive adjuvant EBRT are
Table 2. Results of clinical biomarkers on different dates known to have increased complication rates with no impact
on survival. 13,14 Use of EBRT should be limited to special
Biomarker Date Value/Finding circumstances. Patients with pelvic mass not yet diagnosed
HbA1c PAD 0 10.7% and leukocytosis, especially those with prior radiation to
(normal 4.0 – 6.0%) PAD 1 10.7% the affected area, should be started on empiric antibiotics

Ca-125 PAD 0 147 units/mL as first line therapy. Patients with endometrial cancer
PAD 1 147 units/mL and comorbid obesity often experience diagnostic delay,
15
WBC PAD 0 16.3×10 /L weight stigma, and other barriers and require careful case
9
(normal 4.0 – 11.0×10 /L) PAD 1 16.3×10 /L consideration and continued advocacy, as was provided in
9
9
this case. We are very grateful to this patient and her spouse,
9
PAD 5 25.2×10 /L who was an excellent support for her during this time.
Lactate PAD 0 2.3 mmol/L
(normal 0.5 – 2.2 mmol/L) PAD 1 2.3 mmol/L Acknowledgments
Infectious workup PAD 5 Negative The authors thank Jessica Pudwell for her assistance with
PAD 18 Blood culture positive for obtaining ethics approval.
Klebsiella pneumonia and
Citrobacter koseri Funding
Abbreviations: PAD: Post-admission day; WBC: White blood cell.
None.
abscess secondary to a bowel microperforation, which was Conflict of interest
successfully managed with drainage and antibiotics.
The authors declare that they have no competing interests.
Several challenges limited our ability to make a timely
diagnosis in this case. A delayed presentation of infection Author contributions
from the initial surgery and radiation therapy made infection
a less likely probability. The initially stable size of the pelvic Conceptualization: Jennifer McCall, Jena Hall
collection and absence of other infectious symptoms did not Supervision: Elena Park
suggest abscess. Leukocytosis was a clue that an infectious Writing – original draft: Jennifer McCall
process was at play but is also a non-specific marker that can Writing – review & editing: Jennifer McCall, Jena Hall
be implicated in inflammatory processes including neoplastic
disease. The difficulty in obtaining an adequate sample due Ethics approval and consent to participate
to multiple factors including the patient’s body habitus and The Queen’s University Health Sciences and Affiliated
comorbid anxiety added to diagnostic delay. However, our Teaching Hospitals Research Ethics Board (HSREB) have
persistence in determining a cause, our dedication to listen granted ethics clearance for this study (No: OBGY-413-22).

Volume 3 Issue 1 (2024) 4 https://doi.org/10.36922/gtm.2114