RESECTION OF A 303.2-POUND OVARIAN TUMOR

A woman with a 303.2-pound ovarian mass is presented. She had been bed ridden for the previous 2 years and housebound for 6 years due to the enlarging mass. Psychological factors enabling this patient to remain home and sabotage attempts of her family to obtain help must be consid ered and dealt with while obtaining preoperative consultation with eac h of the services ultimately to be involved in the patient's care. Psy chiatric, pulmonary, nutritional, cardiac, endocrinologic, reconstruct ive surgery, anesthesia, and operating room nursing assessment and adv ice should be sought. Despite the large size, there is a one-third cha nce of finding a malignancy, suggesting that all of these large masses should be removed intact whenever possible. An elliptical transverse incision from iliac crest to iliac crest offers the best preservation of abdominal wall anatomy and function. Invasive cardiac and pulmonary monitoring should continue through the operation and afterward, as se vere cardiopulmonary/hemodynamic compromise is possible. Long-term psy chiatric follow-up is needed as the dramatic anatomic restoration is n ot always accompanied by a similar psychologic restoration. (C) 1994 A cademic Press, Inc.