Perioperative Anesthetic Challenges and Multidisciplinary Management of a Massive Intra-Abdominal Tumor

Massive intra-abdominal tumors are associated with major perioperative anesthetic and surgical challenges due to respiratory compromise, hemodynamic instability, difficult positioning, fluid shifts, and postoperative complications. We present the case of a 65-year-old woman with a giant ovarian tumor weighing approximately 21 kg who underwent successful surgical resection following multidisciplinary perioperative management. A massive abdominal cystic lesion occupying most of the abdominal cavity, compressing abdominal organs, and associated with thoracic abnormalities was identified. Surgical treatment included hysterectomy, omentectomy, appendectomy, and cystectomy. The novelty of this case lies in the extreme tumor size, the severe positional hemodynamic instability caused by inferior vena cava compression, and the intraoperative confirmation of increased intra-abdominal pressure requiring immediate adaptation of anesthetic and surgical management. Despite the complexity of the case, the patient had a favorable perioperative course. This case highlights the importance of careful anesthetic planning, respiratory optimization, invasive monitoring, and multidisciplinary collaboration in the management of giant abdominal tumors.