Twist of fate: Acute small-bowel volvulus caused by a giant mesenteric desmoid-type fibromatosis: A case report and literature review

Abstract

Desmoid-type fibromatosis (DTF) is a rare, benign but locally aggressive fibroblastic neoplasm that lacks metastatic potential yet may cause significant morbidity due to local invasion and mechanical complications; intra-abdominal or mesenteric involvement is uncommon and may rarely present with acute intestinal obstruction or volvulus. We report a 30-year-old female who presented with a 3-day history of severe abdominal pain, progressive abdominal distension, and absolute constipation, in whom contrast-enhanced CT demonstrated a large mesenteric soft-tissue mass measuring approximately 16 × 12 cm associated with twisting of small-bowel loops around the mesenteric pedicle, consistent with small-bowel volvulus and closed-loop obstruction; emergency laparotomy with derotation and complete excision was performed, and histopathology confirmed mesenteric DTF, with no recurrence at 6-month follow-up. This case highlights that mesenteric DTF, although benign, can present dramatically with life-threatening mechanical complications and emphasizes the importance of prompt CT diagnosis, urgent surgical management, and histopathologic confirmation, as well as awareness of this rare presentation among radiologists and surgeons to reduce morbidity in acute settings.