Resection of a Giant Ovarian Tumor the Management Challenge

Abstract

A 20 year old woman (100Kg, 161cm abdominal girth) was admitted for evaluation of massive abdominal distension. Her abdominal ultrasound revealed a giant ovarian tumor. Preoperative interdisciplinary conferences were done in optimizing the patient and planning for the surgery. She was received lying in her heft with difficulty of breathing. Surgical plan at that time was to gradually drain the cyst using local anesthesia under Monitored Anesthesia Care. 15L of cystic fluid was drained preoperatively before the decision to remove the tumor completely under general anesthesia was performed. General anesthesia was induced, with the patient in slight left lateral position with 2mg Midazolam, 50mg Ketamine, 3mg atracurium and 80mg Succinylcholine. There were episodes of hypotension intraoperatively managed by fluid resuscitation and the use of vasopressors. Intraoperatively, a total of 48L of cystic fluid from the mass was removed. Patient was kept intubated and closely monitored post-operatively and was sent home 4 weeks post-surgery improved and stable. This case shows us that it would be safer for a patient with a large ovarian tumor causing cardio respiratory distress to have gradual drainage of cystic fluid first under MAC before considering total removal of the tumor under general anesthesia.