Sporadic aggressive fibromatosis of the colon and abdominal wall in an emergency setting.

AIM

Our aim is to present an utterly unique case of sporadic aggressive fibromatosis (AF), infiltrating both the abdominal wall and the colon; and especially, to discuss the usefulness of porcine dermal meshes for the reconstruction of a large parietal gap in contaminated surgery and in an emergency setting.

CASE EXPERIENCE

We report the case of a 40 years old woman affected by sporadic AF, involving both the anterior abdominal wall and the colon, with an effective intestinal stricture. The surgery consisted in removing "en bloc" the portions of the colon and abdominal wall affected by fibromatosis, with no residual tumor (R0), that left an important parietal gap. A biological prosthesis of cross-linked acellular porcine dermal collagen (APDC) has been used for the contextual reconstruction of the abdominal wall, sutured inlay by a double line of non absorbable stitches. No complications have been observed. After one year follow up, there is no tumour recurrence and the abdominal wall has fully consolidated.

DISCUSSION

The peculiar problems arising about differential diagnosis, therapeutic indications and reconstructive surgical procedures are discussed, especially with regard to prosthetic implants in contaminated surgery and to cross-linked APDC prosthesis.

CONCLUSIONS

Complete surgical removal is the first line treatment in sporadic AF, whenever feasible. In the reported case, an R0 resection was obtained at the cost of a wide parietal gap. According to our experience, cross-linked APDC is effective for the prosthetic reconstruction of abdominal wall in contaminated surgery and in an emergency setting.

KEY WORDS

Abdominal wall, Aggressive fibromatosis, Desmoid tumor, Prosthetic devices, Reconstructive surgical procedures, desmoid tumor.