Extremely Large Intra-Abdominal Fibromatosis Presents as a Life-Threatening Surgical Emergency (ENTIRE ARTICLE)

Summary

A 65 years old, heathy female patient, presented to our Emergency Medicine Department with severe lower abdominal pain of acute onset, associated with nausea and recurrent vomiting. Abdominal examination upon her admission revealed diffuse peritonitis, with a tender palpable mass on the mid abdomen. Per rectum exam was normal. A contrast enhanced computed tomography (CT) scan showed large space occupying lesion of 10*12 cm at left mid-lower abdomen, penetrating into small bowel loop, with free intra-abdominal air and fluid. On exploratory laparotomy, large amount of purulent fluid was demonstrated, along with a large (about 12 cm diameter) soft tissue tumor attached to several bowel loop with small intestine perforation due to tumor penetration. Resection of the tumor with long segment of small bowel, along with primary anastomosis was completed. Her post-operative period (POD) was uneventful, and she was discharged home on POD 6. Histopathological exam of the specimen with hematoxylin and eosin stain showed Mesenterial tumor of Intraabdominal fibromatosis (desmoid), invading to the wall of small intestine with perforation and peritonitis. Surgical margins of mesenterium are free of tumor. Reactive lymph nodes seen in mesenterium.