A Rare Cause of Massive Intraabdominal Mass: A Challenging Exploratory Laparotomy

Abstract

Purpose: Desmoid-type fibromatosis is a rare, histologically benign but locally aggressive soft tissue tumour that can closely mimic intra-abdominal malignancies, often resulting in delayed diagnosis and complex surgical management. This case report aims to describe the clinical presentation, diagnostic challenges, surgical management, and postoperative outcome of a patient with massive intra-abdominal desmoid-type fibromatosis in a resource-limited Sub-Saharan African setting.
Methodology: A 49-year-old male presented with progressive abdominal distension, weight loss, and bilateral lower-limb oedema. Clinical evaluation, radiological imaging, exploratory laparotomy, histopathological examination, and postoperative follow-up were undertaken. Intraoperative findings revealed a large intra-abdominal mass densely adherent to adjacent bowel loops, requiring en bloc resection with the involved intestinal segments.
Results: Histopathological examination confirmed desmoid-type fibromatosis, characterised by spindle-cell proliferation without evidence of malignant transformation. The patient had an uneventful postoperative recovery, demonstrating that complete surgical excision remains an effective treatment option where advanced molecular diagnostics and systemic therapies are unavailable.
Novelty and Contribution: This report contributes to the limited literature on intra-abdominal desmoid-type fibromatosis from Sub-Saharan Africa by highlighting its unusual presentation, the diagnostic difficulties associated with distinguishing it from malignant abdominal tumours, and the continued importance of surgical management in low-resource healthcare settings.
Social and Practical Implications: The case underscores the need for increased clinician awareness, earlier recognition of desmoid tumours, and strengthened diagnostic capacity in resource-constrained environments. Improving access to histopathological services and multidisciplinary surgical care could facilitate timely diagnosis, optimise treatment outcomes, and reduce morbidity among patients with rare soft tissue tumours.