Mesenteric Desmoid and Surgery

The presence of mesenteric DT can be incidentally discovered at the time of total colectomy and can preclude the scheduled procedure on account of technical reasons. In the experience of the Saint-Antoine Hospital of Paris, the presence of mesenteric DT ruled out construction of IPAA (three patients), conversion of an ileo-rectal anastomosis into an IPAA (three patients), removal of the rectum for carcinoma (two patients), construction of a continent ileostomy (two patients) and duodenal-pancreatic resection (two patients) [13]. According to Hartley et al. [113], this situation was discovered in 3% of the patients submitted to a first laparotomy and in 30% of those submitted to a second laparotomy, and also influenced the scheduled surgical procedure, generally IPAA. Similarly, Cohen observed significant mesenteric desmoid disease at the time of the attempted IPAA in seven patients and a definitive ileostomy was necessary [114].

The presence of a fibrous mesenteric mass or a mesenteric fibromatosis may preclude the construction of an IPAA for two reasons: (1) the shortness of the mesentery, (2) the impossibility of folding the ileal loops. In these cases we were able to perform a straight ileo-anal anastomosis since the terminal ileum must not be folded and can be carried down to the anal canal more easily than to the pouch, allowing the ileo-anal anastomosis to be performed without tension. However, the straight ileo-anal anastomosis has been abandoned on account of the unfavourable functional results. In our experience, multiple longitudinal myotomies of the last 15 cm of ileum provide a satisfactory functional result [115].

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