Pelvic desmoid tumor: threat to mother and fetus

Desmoid tumors (DTs) are well-recognized extracolonic manifestations of familial adenomatous polyposis. Surgical trauma and hormonal changes during pregnancy have been proposed as etiologic factors. We present a case of a rapidly growing pelvic DT arising from a J-pouch in a 27-year-old pregnant woman status postcolectomy with ileoanal J pouch anastomosis. The tumor interfered with the normal maturation and delivery of the fetus as well as the patient's ability to void or defecate prompting surgical intervention with resection of the tumor and adjacent J pouch at 23 weeks gestation. There are no other reports in the literature of pelvic DT requiring resection during pregnancy. Pelvic DTs in this scenario are potentially fatal to both mother and fetus secondary to uncontrolled bleeding. Surgical intervention should be limited to resection of tumor and when necessary the ileal pouch to minimize bleeding complications.