AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | 44 CASE REPORT African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 2 | 2025 | Large Adnexal Tumour in a Young Woman Presenting with Cardiac- related Signs and Symptoms furosemide 40 mg q12h to treat the volume overload and the peripheral oedema, and carvedilol 3.125mg q12h to manage the tachycardia. Oxygen was administered through a nasal cannula to supplement the oxygen supply. The patient was initiated on a high protein diet and additionally, supplemented with thiamine and multivitamins. After the patient’s condition was optimised, a midline laparotomy was performed. On peritoneal entry, about 500 mL of clear ascitic fluid was drained and sent for cytology. The very large cyst measuring 30 x 40 cm was discovered to have originated from the right ovary, and a right-sided adnexectomy and omentectomy was done. The cyst was removed intact. The patient was admitted postoperatively to the high-care unit. Her postoperative stay in the unit was largely uneventful and she was transferred to the ward after two days. Final pathology of the ovary revealed a mucinous cyst adenoma. Serial echocardiogram examinations post- operatively showed gradual improvement of the cardiac activity in the subsequent months. Six months post operatively the patient had EF of 61% . Subjectively the patient also reported significant improvement of her dyspnoea. DISCUSSION Large adnexal tumours, typically defined in the published literature asmeasuringmore than 10 cmare rare. 1 These tumours can create a pressure effect that can cause severe cardiovascular and respiratory complications. Very large tumours can compress the inferior vena cava (IVC), resulting in diminished blood flow blood back to the heart. This leads to high venous pressure at the lower extremity level causing bilateral oedema. 2 This can also result in venous thrombosis in some cases. The low venous return or lack of preload, lowers blood flow leading to poor systemic circulation and delivery of oxygen to the vital body organs which may result in fatigue, low blood pressures and organ failure. Moreover, the pressure effect by the tumour elevates intra- abdominal pressure (IAP) moving the diaphragm upwards.2 This limits lung expansion and decreases functional residual capacity and can cause dyspnoea and atelectasis. The high IAP causes an increase in intrathoracic pressure and has the effect of applying external pressure on the heart. The consequence of this is a decrease in ventricular compliance and diminished diastolic filling affecting haemodynamic stability. In severe cases, abdominal compartment syndrome can develop. Compression-related symptoms that can be experienced, include symptoms of heart failure such as dyspnoea, orthopnoea, oedema and generalised fatigue. Preoperative planning is essential in the management of these cases. Cardiac function optimisation, fluid, electrolyte and nutritional support, are also important. Potential circulatory system complications may arise from hypotension syndrome caused by compression of major blood vessels by the tumour when the patient is in the supine position. 3 Tumour removal can lead to a decrease in intrathoracic and intracavitary pressure, resulting in hemodynamic instability. To mitigate this risk, slow intraoperative drainage at a rate of 0.5–1 litre per minute is recommended. 4 Because of the considerable physiologic changes that surround the removal of very large ovarian tumours, postoperative care of the patients should be done in an intensive or high-care unit.3 Having continuous cardiopulmonary monitoring is important to identify any arrhythmias or changes in the respiratory condition. Sequential monitoring of renal function will facilitate early detection of possible acute kidney injury. Appropriate post- operative surveillance enables early action in the event of any haemodynamic instability leading to a significant reduction in morbidity and mortality and maximising the recovery. Although very large ovarian tumours with systemic cardiovascular impact are uncommon, some cases have appeared in the medical literature, mainly as case reports. All these reports do reveal that huge adnexal tumours are capable of exerting significant mechanical compression of vital structures, which can induce cardiopulmonary compromise due to multiple physiological processes such as IVC blockage, diaphragmatic elevation, and direct cardiac compression. 2 The supporting literature is entrenchedwith the fact that total surgical resection is likely to lead to a quick resolution of suchmechanical effects with the majority of the patients experiencing marked improvement in their respiratory and cardiac performance after the procedure. CONCLUSION This case illustrates the rare but serious complications which may develop as a consequence of a very large adnexal tumour. These tumours are typically benign in most cases, but compression on neighbouring anatomical structures can adversely affect other organ systems including the cardiovascular system. The key to successful outcomes includes a multidisciplinary approach and meticulous management of the perioperative care. The knowledge base of these cases are mostly presented as case reports or miniseries, which makes it difficult to base clinical decisions on available research. KEY POINTS: 1. Systemic Effects: The presence of huge tumours can impede the IVC (leading to oedema) and the heart (which loses preload/compliance) and also interfere with respiration due to displacement of the diaphragm. 2. Multidisciplinary care: In the case of the patient, the cooperation of cardiology, critical care, and gynaecology was critical toward perioperative stability. 3. This case also highlights the importance of appropriate referral to a tertiary centre, as these patients should not be managed as part of a multidisciplinary team. 4. Surgical precaution and anaesthetic expertise, anticipating a sudden drop in blood pressure: Haemodynamic collapse as a result of sudden decompression should be avoided by controlled removal of the tumour. 5. Outcome: excision of the tumour corrected cardiac dysfunction, which shows the importance of initial treatment of giant tumours in symptomatic cases. The case demonstrates the significant systemic consequences that very large adnexal tumours pose with regard to life and the significance of personalised care that involves teammanagement. REFERENCES ¡ ¸ ¤ ¢ ¦ ¦ ¢ ® ¤ © ª © ª ¢ ¦