Fifty-one-year-old female with abdominal pain, diarrhea, flushing, and heart murmur for exploratory laparotomy

The case A 51-year-old, 59-kg woman was admitted to the hospital for elective exploratory laparotomy and resection of a pelvic mass, thought to be ovarian carcinoma. The patient gradually developed increasing abdominal and lower back pain, weight loss of 6 pounds, cough, nausea, and diarrhea over the course of 1 year. She also noted some facial flushing, described as redness of the central face that was persistent but would worsen from time to time, without any precipitating factor. Her medical history was significant for chronic anxiety disorder and mitral valve prolapse. During the preoperative physical examination, the patient's heart rate was 120 beats per minute, and arterial blood pressure was 105/75 mmHg. There was redness of her central face, which was described as “facial rosacea” by the evaluating physician. A grade II/VI systolic ejection murmur was noted along the left sternal border, without radiation. She had increased bowel sounds. A firm, 18-week-sized uterus with a globular mass at the fundus was palpable. The remainder of her exam was unremarkable. Laboratory investigations were unremarkable, with the exception of a hematocrit of 24.4 vol %. A colonoscopy to evaluate for chronic diarrhea was normal. An ultrasound of the abdomen and a computed tomographic scan showed bilateral ovarian masses within the pelvis, with ascites and a moderate right pleural effusion. The patient stated that a transthoracic two-dimensional echocardiography from 5 years ago (taken for her history of mitral valve prolapse) was normal, but these results were not available.