Emergency surgery for a ruptured intra-abdominal desmoid tumour.

Dear Editor, Desmoid tumours are fi brous benign tumours that are often indolent until local symptoms evolve.1 We highlight a rare case of a ruptured intra-abdominal desmoid tumour presenting as acute abdomen. A 58-year-old female presented to our institution with a 1-day history of abdominal pain and vomiting. This was associated with fever, chills and rigors. On examination, the abdomen was tender in the peri-umbilical area with some guarding. Laboratory investigations were largely unremarkable except for a mildly raised white blood cell count of 10.9 x 109. Computed tomographic (CT) scan of the abdomen was performed and it revealed a mass in the small bowel mesentery with signifi cant ascites (Fig. 1). Our initial impression was either gastrointestinal stromal tumour or mesenteric teratoma. In view of the persistent abdominal signs, exploratory laparotomy was performed. During the surgery, there was a ruptured tumour in the jejunal mesentery with 1 L of purulent ascites (Fig. 2). The tumour was located 20 to 25 cm from the duodeno-jejunal fl exure with surrounding induration. Even though the bowel was not involved, resection of the tumour would result in vascular compromise of the small bowel. Hence, small bowel resection with hand-sewn endto-end anastomosis was performed. She was discharged well on the 6th postoperative day. Histological evaluation of the jejunal specimen confi rmed the diagnosis of a desmoid tumour. The lesion extended to the resection margin and abutted the serosal surface. The fundamental principles in managing any patient with life-threatening intra-abdominal septicaemia must be the preservation of life and the containment and eradication of the source of sepsis. In our patient, after commencement of intravenous antibiotics and ample fl uid resuscitation, exploratory laparotomy was warranted as the source of the peritonitis was localised to the abdomen as delineated by the CT scan. Copious amount of irrigation was necessary in view of the extensive contamination. It was only after histological evaluation that the perforated tumour was diagnosed as an intra-abdominal desmoid tumour. Desmoid tumour is a rare lesion representing <3% of all soft tissue tumours with an estimated incidence of 2 to 4 new cases per million per year.2 Its association with familial adenomatous polyposis and Gardner’s syndrome has been well described.2 Emergency Surgery for a Ruptured Intra-abdominal Desmoid Tumour