Mid-abdominal bulging after breast reconstruction due to peritoneal carcinomatosis of advanced gastric adenocarcinoma

SummaryAbdominal bulging is a relatively common complication after autologous breast reconstruction using abdominal tissues. These are usually managed conservatively for a few months before operative treatment, which consists of reinforcing the rectus sheath either using prosthetic materials or by fascia plication. Postoperative abdominal bulging after deep inferior epigastric perforator (DIEP) free-flap breast reconstruction was managed with rectus-sheath plication in a 43-year-old female patient. On recurrence of symptoms, further studies were carried out, and poorly differentiated signet-ring-cell gastric adenocarcinoma with peritoneal carcinomatosis was diagnosed. Other than weakening of the rectus sheath, increased intra-abdominal pressures from malignant ascites should be considered as an aetiology for abdominal bulging after DIEP free flaps. As surgeons, we should never overlook the possibility of rare causes of any postoperative complications.