Giant ovarian masses, gynecologic, anestetic and pathologic assessment; analysis of four cases

Ovarian masses sometimes can be seen as bulky masses reaching to huge amounts. Most pathologic signs can be attributed to compression effect on intraabdominal organs, vascular structures and ascites made by tumor. After removal of such huge pelvic masses, serious clinical hypotension and inferior vena cava (IVC) syndrome can be seen related to the aspiration of high levels of fluid or resection of bulky mass. Here, we present four cases of bulky ovarian masses by means of gynecologic surgery, anaesthesia and pathology.
Case: 54, 35, 39, 42 years old patients having 20 kg and 40x20cm; 14 kg and 40x40x40 cm, 17 kg and 45x50 cm and 53x50 cm adnexal masses respectively were operated. Histopathologies were found each to be the first two borderline mucinous carcinomas, third one was benign endometrioid tumor and the fourth one was mucinous cystadenoma complexed with teratom structures. On preoperative assessment, patients had dyspnea and tachypnea due to huge abdominal distention, blood gas parameters were hypoxic. To prevent supin hypotensive syndrome and other complications peroperatively, cases were evaluated by anesthesiology and the appropriate anesthesia technique was chosen, no major complications were seen in the peroperative or postoperative periods.
Discussion: Giant ovarian cyst excision may be associated with significant mortality. Most of the problems are due to the size of the cyst and to the patient‘s poor condition. Serious problems in this case mainly develop because of intraoperative blood loss and duration of the operation, postoperative hypotension and electrolyte disorders may be seen. Special attention should be paid to ventilator monitoring and hemodynamic assessment peroperatively and intraoperative fluid imbalance, hypotermia and coagulopathy regulation and the operative approach in the planning area needs to be done carefully.

Ovaryan dev kitlelere yaklaþým; jinekolojik, anestetik, patolojik yaklaþým; dört olgu sunumu

Ovaryan kitleler bazen dev boyutlara ulaþabilirler. Bu yüzden de diðer komþu organlara, büyük damarlara kompresyon uygulayýp patoloji yaratabilir, asit oluþturabilirler. Bu derece büyük kitlelerin çýkarýlmasý sýrasýnda çok fazla sývý aspire edilmesine veya dev kitlenin çýkarýlmasýna baðlý olarak ciddi hipotansiyon ve Ýnferior Vena Cava (ÝVC) sendromu oluþabilir. Burada bu þekilde olan dört olguyu
jinekolojik, patolojik, anestetik açýlardan sunmak istedik.
Olgu: 54, 35, 39 ve 42 yaþýnda olan hastalar sýrasýyla 20 kg ve 40x20cm; 14 kg ve 40x40x40 cm; 17 kg ve 45x50cm; ve 53x50 cm kitle saptanýp opere edildiler. Histopatolojik tanýlarý sýrasýyla ilk ikisi borderline müsinöz adenokarsinom, benign endometroid tümör ve son olarak müsinöz kistadenoma eþlik eden teratom þeklindeydi. Preoperatif deðerlendirmede, hastalarýn aþýrý abdominal distansiyona baðlý dispne ve taþipnesi vardý ve kan gazlarý hipoksikti. Supin hipotansiyon ve diðer major komplikasyonlarý önlemek için gerekli operatif tedbirler alýnarak uygun anestezi tekniði ile opere edildiler. Major peroperatif ve postoperatif herhangi bir komplikasyon oluþmadý.
Tartýþma: Dev kitle eksizyonlarý önemli morbidite ile beraber olabilirler. Bu genelde kitlenin büyüklüðüne ve hastanýn kötü kondisyonlarýna baðlýdýr. Eðer operasyon için gerekli tedbirler alýnmazsa dev kitleler kanama ve hipotansiyon, elektrolit bozukluklarý ile beraber belirgin morbidite ve ciddi problemlere sebep olurlar. Bu yüzden ventilatörle monitorizasyon, hemodinamik deðerlendirme, hipotermi ve koagülopati için uygun tedbirler alýnýp operasyona multidisipliner hazýrlanmalýdýrlar.