ObjectiveTo analyze the reasons for misdiagnosis of gastrointestinal metastatic ovarian cancer, in order to increase the rate of correct diagnosis and treatment, and to investigate the prognostic factors. MethodsWe retrospectively analyzed the clinical features, pathological features and prognostic factors of 43 cases of metastatic ovarian carcinoma from gastrointestinal tract treated between 2004 and 2014. ResultsGastrointestinal metastatic ovarian cancer was characterized by the diversity of clinical manifestations and lack of specific symptoms. The common initial symptom was pelvic mass, frequently accompanied with gastrointestinal symptoms of ascites, anemia or weight loss, abdominal pain, bloating, gastrointestinal obstruction and bleeding. Signs and symptoms of primary and secondary tumor sites often coexisted with each other, leading to misdiagnosis. Univariate analysis showed that primary site, histological type, surgical treatment, the residual tumor debulking size, lymph node metastasis, tumor invasion and standard chemotherapy had significant impacts on the prognosis (P < 0.05). ConclusionsGastrointestinal metastatic ovarian cancer occurs in premenopausal women, often with ascites, abdominal pelvic masses as the first symptom. Primary tumor site is often ignored, and the initial correct diagnosis rate is low. Metastasis from stomach cancer is the most common, followed by colorectal cancer and esophageal cancer. Prognosis is correlated with the primary site, histological type, degree of differentiation, depth of invasion, lymph node metastasis and other factors. Radical surgery and chemotherapy can improve survival.