Laparoscopic drainage of an intra‐abdominal desmoid abscess – a video vignette

Abstract

Desmoid tumours (DTs) are locally aggressive, benign tumours of fibroblastic origin. Up to 15% of DTs are associated with familial adenomatous polyposis. Mesenteric DTs in this cohort are associated with a worse prognosis due to secondary obstruction or abscess formation. Although degeneration into an abscess is rare, the management options remain unclear. Video S1 demonstrates our experience with laparoscopic drainage of a mesenteric desmoid abscess. The patient was a 29-year-old woman with known familial adenomatous polyposis and a mesenteric DT, who presented to our unit with a 3-day history of abdominal pain and fever. CT scan on admission demonstrated abscess formation within the known mesenteric DT. Despite 1 week of conservative management, there was no clinical or biochemical improvement in the patient's condition. Following a multidisciplinary team discussion, surgical drainage via a laparoscopic approach was utilized for source control. The video demonstrates careful mobilization and dissection of adherent small bowel from the desmoid abscess, and the subsequent creation of a safe area through which the abscess could be drained. Following drainage, intra-abdominal drains were left in situ until an interval scan was performed. This demonstrated complete resolution of the collection and the drains were subsequently removed. At 6 weeks' follow-up, the patient has required no further interventions or admissions. In units with significant expertise in minimally invasive surgery, laparoscopic drainage of a mesenteric desmoid abscess is a safe and feasible intervention in patients presenting with sepsis refractory to medical management.

Familial adenomatous polyposis associated with desmoid tumors presenting with abdominal abscess

“…[3] There are only 8 case reports about degeneration of intra-abdominal DTs into abscess in literature (Table 1) thus far. [3,[8][9][10][11][12][13][14] Among 10 patients reported, 5 patients were diagnosed with FAP and 5 patients without FAP. The pathological mechanism about DTs complicated with abscess is not completely clear.…”

“…Kai Huang et al [12] 2017 1 None Percutaneous drainage (1) + antibiotics (1) 11 mo No recurrence 7 M. Alam et al [13] 2020 1 1 Percutaneous drainage (1) + antibiotics (1) 6 wks No recurrence 8…”

“…However, the intra-abdominal abscess formation in DTs is rare [3] . There are only 8 case reports about degeneration of intra-abdominal DTs into abscess in literature (Table 1) thus far [3,8–14] . Among 10 patients reported, 5 patients were diagnosed with FAP and 5 patients without FAP.…”

Laparoscopic approach in postpartum pyoperitoneum: A guide to early rehabilitation

“…Although laparoscopic drainage is documented in the literature, this has not, to our knowledge, been documented for the pyoperitoneum in a parturient. 1,2 A gynaecologist may be wary of this approach, either because of inexperience with the technology, or its widespread accessibility. In our series of six cases, we provide a detailed description and its outcome.…”

“…Although laparoscopic drainage is documented in the literature, this has not, to our knowledge, been documented for the pyoperitoneum in a parturient. 1,2…”