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Case of Ovarian mass with chronic hypotension

An interesting case presented to us two months ago in the month of August with Shortness of breath, abdominal distension.
The patient complained that she was not able to pass stools since four days  for which she took some home remedies. However, the condition did not relieve and she developed abdominal distension and shortness of breath for which she sought medical attention.
Upon eliciting this history, a CT scan was suggested for the abdomen. The report showed mass in the ovary.
An laparotomy was done to perform Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy.
The patient developed hypotension on the table and the surgeons were forced to stop the surgery after excision of the mass.
The mass measured 6,600 grams and the specimen was sent to histopathological examination. The report came out to be clear cell carcinoma of the ovary.
The levels of CA125 were raised. (196 IU/ml)
After the patient was discharged in early September, she was referred to an oncologist. The oncologist suggested for the TAH to be completed and the patient presented again on 22nd October for the above reason. The patient was still found to be hypotensive.
The patient is a known diabetic since 4 years and she is using Metformin 500mg.
She was married 24 years back and was divorced. She hasn't conceived any kids.
Her menstrual history is normal. She attained menopause at the age of 45.
Patient is a k/c/o paranoid schizophrenia and is on medication (Risperidone and Hexaphendyl).

ON EXAMINATION:
The patient appears very pale and has generalized edema.
The patient seems to be mildly dehydrated.
BP is 70/40 mmHg in right arm in both sitting and standing positions.
Pulse is 90/min.
Other systems are normal.
The following investigations were ordered













Bed-side 2D Echo

Coomb's test

ABG


The patient did not carry the older reports. As soon as we obtain them, they will be updated.


TREATMENT GIVEN:

  1. INJ. NORADRENALINE DRIP /IV to maintain MAP > 65mmHg
  2. INJ. CEFIXIME 1g/ IV/ BD
  3. INJ. METRONIDAZOLE 100ml/ IV/ TID
  4. INJ. PANTOPRAZOLE 40mg/ IV/ OD
  5. INJ. ONDANSETRON 4mg/ IV/ SOS
  6. INJ. ASTYMINE FORTE/ BD
  7. IVFs 2 pints RL and 2 pints NS @ 100ml/min
  8. Both lower limbs elevation
  9. 1 unit (300 ml) Packed RBCs (PRBC) was transfused.
Post transfusion blood picture is below

Discussion around this patient...







The patient is still in the ICU and suggestions on approach to the patient are required.
Any new details about the patient will be soon updated. 

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