Hazards in the management of large intra-abdominal tumours

Whatever their nature, large intra-abdominal tumours interfere with respiratory and circulatory function by producing elevation and splinting of the diaphragm and partial occlusion of the inferior vena cava. The main hazards involved in removing such tumours are consequences of abdominal decompression, which may produce a labile cardiovascular state, respiratory difficulties, and rapid intestinal distension. A knowledge of the deranged physiology and its management may avert these complications. Careful preparation, modification of anaesthetic technique, postoperative ventilation, and external abdominal compression are important. To illustrate the discussion two cases of large ovarian cysts are described.