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Moreover, it highlights some operative challenges including dealing with associated gastric perforation and mitigating the risk of abdominal compartment syndrome. We hope our approach to management can help guide others faced with similar challenging cases. Moreover, it highlights some operative challenges including dealing with associated gastric perforation and mitigating the risk of abdominal compartment syndrome. Rhabdomyosarcoma (RMS) is a malignant mesenchymal neoplasm uncommon in adults. We report the case of an alveolar rh