Ovarian cyst

Abstract

Without treatment ovarian tumours may enlarge to massive proportions. Spohn' reported the removal of a tumour weighing nearly 150 kg (328 lb). This was the largest which was recorded amongst papers studied in a review of the literature by the authors-appropriately this was in Texas. This report concerns a case of respiratory arrest precipitated by an enormous ovarian cyst. Case reportA 57-year-old woman, with a huge abdominal swelling, was admitted in extreme respiratory distress to the casualty department. There was gross pitting oedema of the whole body and engorged veins in the neck and over the anterior abdominal wall. A provisional diagnosis of massive ovarian cyst was made with cardiac failure secondary to compression of the lungs, mediastinum and inferior vena cava.Immediately after arrival the patient sustained respiratory arrest and she was intubated with an 8.0 mm cuffed 'Portex' endotracheal tube. Intermittent positive pressure ventilation with 100% oxygen was followed by a rapid return of spontaneous respiratory activity. Pancuronium 6 mg was given intravenously and ventilation was continued using a Manley Pulmovent delivering 50% nitrous oxide in oxygen. A minute volume of 6 litreslmin, with a tidal volume of 450 ml, was achieved at an inflation pressure of 70 cm of water. Figure 1 shows the appearance of the patient shortly after intubation.A Teflon catheter was introduced percutaneously via the right external jugular vein into the right atrium and when attached to a central venous pressure manometer a value of 40 cm of water was measured from the sternal angle. The pulse rate was 100 per minute and the blood pressure was 110/60 mmHg.A paracentesis catheter was passed into the swelling and drainage of fluid was started at a maximum rate of 1 litre/h. After 3 litres had been removed the ventilator inflation pressure fell to 35 cmH20. The patient was transferred to the intensive care unit where intermittent positive pressure ventilation was continued employing a Cape ventilator with F102 of 0.35, tidal volume of 700 ml and a frequency of 12/ min. Arterial blood gas analysis showed pH 7.42, Po; 88 mmHg, Pco2 38 mmHg, HCOJ 28 mol/l and base excess + 3*5mmol/l.The cardiac failure was treated with diuretics and the central venous pressure fell to 5 cmH20 after 48 h.After 4 days a total of 44 litres of fluid had been drained from the abdomen, the catheter was then removed and the patient was extubated the following day. However on the sixth day accumulation of fluid began once more and tracheal intubation and ventilation were again necessary.