Management of a Giant Ovarian Tumor More Than 30 kg: A Case Report and Review of the Literature

AkazawaMunetoshi,; SaitoToshiaki,; NagayamaRina,; AriyoshiKazuya,; OkadomeMasao,

doi:10.1089/gyn.2018.0008

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…Regarding intraoperative drainage, an increasing number of researchers prefer slow drainage at 0.5–1 L/min. [ 4 , 5 ] In our case, due to the patient's relatively stable condition and the patient's nervous mood, we drained the ovarian cyst safely during surgery.…”

Section: Discussionmentioning

confidence: 89%

Perioperative management of a patient with a giant ovarian tumor

Cai

Dai²,

Mi³

et al. 2020

Medicine

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Rationale: Giant ovarian tumors are very rare. Patients with large ovarian tumors appear similar to pregnant women and morbidly obese patients. The management of such patients is associated with significant mortality. Therefore, additional clinical research is essential to understanding the perioperative complications of this disease. Patient concerns: We report the perioperative management of a patient with a giant ovarian tumor that contained 23 L of fluid who underwent tumor resection. Given the infrequency of these giant ovarian tumors, a detailed anesthetic plan and postoperative respiratory support strategy were tailored to address the patient's hemodynamic and respiratory risks, as well as to minimize potential complications, including supine hypotensive syndrome, re-expansion pulmonary edema, and postoperative intestinal ileus. To prevent supine hypotensive syndrome, the patient used a mild left-sided position (10∼20°) after admission until the tumor was removed. In order to prevent re-expansion pulmonary edema (RPE), the intraoperative ventilator mode was set to pressure-controlled ventilation (PCV), with the addition of 8 cmH 2 O positive end-expiratory pressure (PEEP). The airway pressure was lower while maintaining a certain tidal volume. In the ICU, in the ventilator mode, we use pressure support ventilation as well as PEEP and adjust it according to the patient's spontaneous breathing situation and blood gas analysis to prepare for further detach from the respirator and extubation. And we prevent the occurrence of postoperative intestinal ileus by placing the abdominal binder after the operation. Diagnosis: Mucinous cystadenoma of the left ovary. Interventions: The patient underwent exploratory laparotomy with debulking of the left ovarian mass, transabdominal hysterectomy with bilateral salpingo-oophorectomy, complete omentectomy with appendectomy, and pelvic lymphadenectomy. Outcomes: After surgery, the patient experienced intestinal distention. Up to now, the patient has recovered well. Lessons: A multidisciplinary approach is essential. Knowing the possibility of complications and choices for management can lead to favorable outcomes in such rare cases. This case reminds us that postoperative complications such as postoperative intestinal ileus may be fatal.

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Section: Discussionmentioning

confidence: 89%

Perioperative management of a patient with a giant ovarian tumor

Cai

Dai²,

Mi³

et al. 2020

Medicine

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“…Intraoperative drainage is often performed at a slow rate of 0.5–1 L/minute [ 17 , 18 ]. Furthermore, there have been reports of the use of FloTrack ® sensors [ 19 ], central veins, and transesophageal echocardiography monitors to control the circulatory system. Although reexpansion pulmonary edema might have developed, hypoxia suggestive of reexpansion pulmonary edema did not occur during or after ovarian aspiration.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a severely obese patient (body mass index 70.1 kg/m2) undergoing giant ovarian tumor resection: a case report

2022

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Background Giant ovarian tumors are rarely seen with severe obesity. There are few reports of perioperative management of giant ovarian tumors and severe obesity. Here, we report the perioperative management of physiological changes in massive intraabdominal tumors in a patient with severe obesity. Case presentation A 46-year-old Japanese woman (height 166 cm, weight 193.2 kg; body mass index 70.1 kg/m2) was scheduled to undergo laparotomy for a giant ovarian tumor. The patient was placed in the ramp position. Preoxygenation was performed using a high-flow nasal cannula, and awake tracheal intubation was performed using a video laryngoscope. Mechanical ventilation using a limited tidal volume with moderate positive end-expiratory pressure was applied during the surgical procedure. The aspiration speed for 15 L of tumor aspirate was set to under 1 L/minute, and the possibility of reexpansion pulmonary edema was foreseen by conventional monitoring. Conclusions We successfully completed anesthetic management in a patient with concomitant severe obesity and giant ovarian tumors.

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Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study

Grăjdieru,

Petrișor,

Bodolea

et al. 2024

JCM

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Background: Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. Methods: This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. Results: Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5–2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. Conclusions: This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.

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Management of a Giant Ovarian Tumor More Than 30 kg: A Case Report and Review of the Literature

Cited by 3 publications

References 16 publications

Perioperative management of a patient with a giant ovarian tumor

Perioperative management of a patient with a giant ovarian tumor

Anesthetic management of a severely obese patient (body mass index 70.1 kg/m2) undergoing giant ovarian tumor resection: a case report

Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study

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