Total pelvic exenteration with extended endo-pelvic resection is an extensive oncologic procedure associated with prolonged operative duration and major blood loss. Perioperative management becomes more complex when the tumor involves large vessels. We report the perioperative management of a 54-year-old hypertensive woman with recurrent uterine sarcoma (low grade stromal sarcoma) who underwent the procedure. The tumor encased the right external iliac, internal iliac, and common iliac veins, with thrombus extending to the bifurcation of the inferior vena cava. Intraoperative blood loss was approximately 6.7–7 liters. She received 11 units packed red blood cells (PRBC), 10 units fresh frozen plasma (FFP), 6 unit’s random donor platelets, 8 units cryoprecipitate, 10 unit’s crystalloids and one unit of 20% human albumin with operative duration of 11hours. A 12 Fr Mahurkar dialysis catheter was placed in the right internal jugular vein to facilitate rapid transfusion. The case highlights pelvic vascular anatomy, massive transfusion protocol, vascular access strategy, electrolyte management, long duration total intravenous anesthesia, analgesic planning and airway strategy. Coordinated teamwork was central to management.

Pelvic exenteration, Uterine sarcoma, Dialysis catheter, Peri-operative management, Massive blood transfusion, Coagulopathy, Team work