Title: Anaesthetic Challenges in Emergency Laparotomy for a Patient with a Unilateral Collapsed and Fibrosed Lung

Background: Tuberculosis (TB) remains highly prevalent in India, and poorly treated cases can lead to long-term pulmonary complications such as lung fibrosis and collapse.Anaesthetic management of such patients particularly in emergency surgeries poses significant challenges due to compromised respiratory function and increased risk of barotrauma with positive pressure ventilation.Case Report: We report the case of a 35-year-old male with a history of childhood TB and right lung collapse, presenting with features of small intestinal obstruction requiring emergency exploratory laparotomy.Preoperative imaging confirmed unilateral lung fibrosis and abdominal TB.Due to his compromised pulmonary reserve, a lung-protective ventilation strategy using low tidal volume and minimal PEEP was adopted under general anaesthesia.An epidural catheter was placed for postoperative analgesia.Intraoperative and postoperative periods were uneventful, and the patient was successfully extubated and shifted to ICU in stable condition.Conclusion: General anaesthesia can be safely administered in patients with unilateral fibrotic lung if tailored ventilatory strategies and meticulous monitoring are employed.Postoperative pain management is crucial to prevent respiratory complications.Individualized perioperative planning based on pulmonary adaptation is key to successful outcomes in such high-risk patients.