Abdominal Wall Reconstruction After Excision of a Giant Desmoid Tumour

Introduction Desmoid tumors are histologically benign proliferations of stromal cells that grow slowly and infiltratively, but may be locally aggressive. They arise from musculoaponeurotic stromal elements. Due to poor response to systemic medical treatment, radical resection and reconstruction should be performed. Material and Methods We present the case of a 24-year-old female patient with abdominal and thoracic tumours, diagnosed in Bangladesh as an endometrioma. She had an increasement of them during her pregnancy. A complementary study was performed showing 4 masses which were biopsied with the result of low-grade mesenchymal tumour. Results After multidisciplinary consensus, a two-stage surgical approach was adopted. First, the thoracic-retroperitoneal mass was removed. Botulinum toxin was then administered to the contralateral side, followed by abdominal surgery. En bloc excision of the entire mass was performed, which was infiltrating the left rectus, obliques and transverse muscles. A dissection of retromuscular preperitoneal disection from central tendon to both Cooper ligaments and from left psoas muscle to the right quadratus lumborum was planned. Then, subsequent reconstruction of the abdominal wall with the combination of absorbable and giant synthetic mesh with reimplantation of muscles into an area of 13 × 10 that was left as a bridge. Only fixation to Cooper ligaments were made. A second synthetic mesh covering the bridge was also implanted as bridge reinforcement. The patient was discharged uneventfully on the 7th postoperative day. Conclusions Radical resection with immediate mesh reconstruction is a safe procedure and can provide definitive cure without functional disability for patients with anterior abdominal desmoid tumours.