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In this case, complex multiple comorbidities, including morbid obesity with a BMI of 62.7, posed significant surgical and anaesthetic challenges. This case highlights the complex diagnostic, intraoperative and perioperative challenges in managing giant ovarian cysts in multimorbid obese patients.<\/jats:p>","DOI":"10.1136\/bcr-2025-267033","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T06:35:28Z","timestamp":1764052528000},"page":"e267033","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Massive serous cystadenofibroma with incidental umbilical endometriosis in a morbidly obese patient presenting as acute respiratory compromise"],"prefix":"10.1136","volume":"18","author":[{"given":"Sujaree","family":"Kuenghakit","sequence":"first","affiliation":[{"name":"Medicine, Warwick Medical School, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Newnham","sequence":"additional","affiliation":[{"name":"University of Warwick, Coventry, UK"},{"name":"University Hospitals Coventry & 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