Resection of a Large Intra-Abdominal Desmoid Tumor with Preoperative Superior Mesenteric Artery Balloon Catheter Placement: A Case Report.

introductionLarge tumors occupying the abdominal cavity can hinder surgical exposure, particularly of the posterior aspect, increasing the risk of arterial bleeding. Because arterial hemostasis is difficult, hemodynamic instability may occur. This report describes the safe use of preoperative balloon catheter placement in the superior mesenteric artery (SMA), the tumor's primary feeding vessel, to control arterial bleeding through on-demand intraoperative occlusion. CASE PRESENTATION: A 40-year-old woman with a history of 2 cesarean sections presented with abdominal distension. An intra-abdominal mass was identified at another institution, and she was referred to our hospital. Contrast-enhanced abdominal CT revealed a large intra-abdominal mass supplied primarily by jejunal branches of the SMA. US-guided biopsy confirmed desmoid tumor. Chemotherapy was also considered; however, debulking surgery followed by chemotherapy was planned to relieve abdominal symptoms. Because the large tumor was expected to limit surgical exposure and increase the risk of intraoperative bleeding, an SMA balloon catheter was electively placed the day before surgery. During surgery, the balloon was inflated on demand by the anesthesiologist at the surgeon's direction before maneuvers carrying a risk of arterial bleeding. Tumor involvement of the small bowel mesentery, transverse mesocolon, small intestine, and duodenum required

conclusionsIn large intra-abdominal desmoid tumors with anticipated limited surgical exposure, preoperative SMA balloon catheter placement may facilitate arterial-bleeding control and improve surgical safety.