Comprehensive perioperative management of a giant neurofibroma complicated by hemorrhagic shock: a case report

Giant neurofibromas are rare benign peripheral nerve sheath tumors, most often occurring in association with neurofibromatosis type I. Tumor rupture may be followed by massive bleeding and hemorrhagic shock, posing life-threatening challenges during perioperative management. This report describes the multidisciplinary perioperative care of a patient with a ruptured giant neurofibroma complicated by hemorrhagic shock. A 39-year-old man with a history of congenital neurofibromatosis presented with acute swelling and pain in the right lumbar region and abdomen following trauma. Computed tomography revealed a massive retroperitoneal hematoma secondary to tumor rupture. The patient underwent emergency debridement and hemostasis under general anesthesia. Intraoperatively, approximately 3,000 mL of clotted blood was evacuated, and diffuse bleeding from the tumor cavity was controlled by suture ligation, electrocautery, and compression packing. Due to severe hemorrhagic shock, the patient required transfusion support, vasoactive drugs, mechanical ventilation, and intensive care. The surgical team focused on precise intraoperative positioning, thermal management, hemodynamic monitoring, transfusion coordination, aseptic technique, and postoperative wound compression and infection prevention. The patient's bleeding was temporarily controlled by compression and intensive supportive therapy. Subsequent multidisciplinary consultation guided further management. The patient achieved hemodynamic stabilization but required prolonged critical care due to the large wound area and ongoing risk of infection. This case highlights the pivotal role of perioperative in managing catastrophic bleeding in giant neurofibroma surgery. Individualized assessment, close coordination with surgical and anesthesia teams, and evidence-based interventions were crucial for maintaining stability and optimizing patient outcomes.