Unusal Ovarian Tumor

A 65 year old woman presented to us with a huge distension of the abdomen for two months. She had had two cesarean sections in the past, the two scars starting froma point above the pubis and diverging through an angle of 5 degrees towards the umbilicus. Clinical examination revealed a 36 weeks' size ovarian tumor. It was confirmed by ultrasonography. We scheduled her to undergo a laparotomy after she was somehow made fit for anesthesia after 1.5 months. The anesthetists said they would give anesthesia only if a ventilator was kept ready for her. That was tricky, since there is always a great demand for ventilators in our institute and we have had to postpone operations of high risk patients a number of times because all ventilators in the institute were in use. Luckily one was available for her on the day we proposed to operate on her. Unfortunately I was asked to attend a meeting and could not operate on her. I asked my juniors to operate anyway, but they did not, because my lecturer did not know how to perform an omentectomy. I was upset, because there would be no guarantee that a ventilator would be available the next week. The woman was indeed lucky. It was available. I operated on her. She was lucky again, because had they opened her abdomen the previous week in my absence, my lecturer would not have been able to handle the situation. The tumor weighed 12 kg. It extended to the pelvic floor below, liver and spleen above, and the flanks on the sides. It was adherent to the anterior abdominal wall on the left side, the small bowel posteriorly on the right and retroperitoneum on the left. I removed the entire tumor, the uterus, tubes, ovaries, and omentum. She had hypotension for two hours (systolic blood pressure of 80 mm Hg, but she recovered well.