Removal of a giant ovarian cyst

Excision of a giant ovarian cyst may be associated with considerable mortality. Problems stem from the size of the cyst and the emaciated state of the patient. We describe a case in which the patient's pre-operative nutritional and psychological state required attention. Gradual pre-operative drainage of a cyst weighing 113 kg was carried out successfully. The main problems intra-operatively stemmed from copious blood loss and the duration of surgery. Postoperatively, ventilatory inadequacy occurred and was probably caused by altered mechanics of ventilation, postoperative pain and pulmonary oedema. We suggest ways in which the management of such cases might be improved.