Management of a massive ovarian cyst

The management of a patient with an ovarian cyst weighing 71.1 kg is described. Preoperative paracentesis did not improve the condition of the patient and should be avoided. Supine hypotension from vena caval occlusion, technically difficult surgery, massive blood replacement, prolonged postoperative ventilatory failure, and persistent bowel distention provided a challenge to the multidisciplinary teams required to manage the largest ovarian tumor reported in 16 years.