Hemorrhagic ovarian rupture after cervical lymph node biopsy in a patient with Stage IV thoracic rhabdomyosarcoma and coagulation disorder: a case report

Abstract

A 13-year-old female was admitted owing to tenacious cough. Her cervical lymph nodes were swollen and the diagnosis of Stage IV thoracic rhabdomyosarcoma, with metastasis to the bone marrow and lymph nodes, was made after imaging tests and an open biopsy of the cervical nodes. After the biopsy, her physical status worsened, and she developed severe coagulation disorder. Seven days after the biopsy, a CT scan revealed bilateral ovarian bleeding and rupture of the left ovary. Accordingly, an emergency laparotomy with left oophorectomy was performed. Ten days later, another hemostasis operation was required to stop subcutaneous hemorrhage at the site of surgical incision. Coagulation disorder due to bone marrow suppression by tumor metastasis and/or chemotherapy is not uncommon in patients with cancer. Our experience illustrates the importance of careful hemostasis during surgery and multidisciplinary hemorrhage prevention after a surgical procedure when a patient has coagulation disorder.