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Ahmed M. A clinician's perspective on the new organ mesentery and non-vascular mesenteropathies. Front Physiol 2024; 15:1336908. [PMID: 39296517 PMCID: PMC11408482 DOI: 10.3389/fphys.2024.1336908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 07/17/2024] [Indexed: 09/21/2024] Open
Abstract
Mesentery was discovered as a new organ in 2017. It is a continuous membranous tissue from the duodenojejunal flexure to the anorectal junction. It has distinct anatomy, physiology, and disease states. Primary mesenteropathies include vascular and non-vascular diseases. Some of them are common, and some of them are rarely seen in clinical practice. Secondary mesenteropathies occur when infection or malignancy in another organ spreads to the mesentery. Each entity has specific diagnostic and treatment protocols. Increased awareness of different mesenteropathies and an understanding of their various presentations at different stages of life can help in early diagnosis and improved clinical outcomes.
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Zhang BF, Liu J, Zhang S, Chen L, Lu JZ, Zhang MQ. Heterotopic mesenteric ossification caused by trauma: A case report. World J Gastrointest Endosc 2024; 16:494-499. [PMID: 39155994 PMCID: PMC11325871 DOI: 10.4253/wjge.v16.i8.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 08/01/2024] Open
Abstract
BACKGROUND Heterotopic mesenteric ossification (HMO) is a clinically rare condition characterized by the formation of bone tissue in the mesentery. The worldwide reporting of such cases is limited to just over 70 instances in the medical literature. The etiology of HMO remains unclear, but the disease is possibly induced by mechanical trauma, ischemia, or intra-left lower quadrant abdominal infection, leading to the differentiation of mesenchymal stem cells into osteoblasts. Here, we present a rare case of HMO that occurred in a 34-year-old male, who presented with left lower quadrant abdominal pain. CASE SUMMARY We report the case of a 34-year-old male patient who presented with left lower abdominal pain following trauma to the left lower abdomen. He subsequently underwent surgical treatment, and the postoperative pathological diagnosis was HMO. CONCLUSION We believe that although there is limited literature and research on HMO, when patients with a history of trauma or surgery to the left lower abdomen present with corresponding imaging findings, clinicians should be vigilant in distinguishing this condition and promptly selecting appropriate diagnostic and therapeutic interventions.
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Affiliation(s)
- Bi-Fang Zhang
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Jiang Liu
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Shuai Zhang
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Ling Chen
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Jia-Zheng Lu
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Ming-Qing Zhang
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
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Karimi M, Mousavi SA. "Heterotopic abdominal wall ossification: A case report" information. Int J Surg Case Rep 2024; 117:109469. [PMID: 38460290 PMCID: PMC10943427 DOI: 10.1016/j.ijscr.2024.109469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Heterotopic ossification is forming a new bone in tissues that do not normally ossify. HO was first reported in 1901 by Askanazy and Lubarsh in a case report study. The range of HO is wide from minute foci to large clinically significant ossification. The incidence of HO in abdominal scars is extremely low. CASE PRESENTATION We present an 84-year-old man referred to our hospital after an unsuccessful elective colostomy reversal in a local hospital. The colostomy was made for fecal diversion after sigmoidectomy due to treatment of sigmoid volvulus about three months ago. The patient had a past medical history of hypertension for 8 years under treatment of amiloride. CLINICAL DISCUSSION In general appearance, the patient was not ill or toxic. Vital signs were normal. Postoperatively Patient did not defecate. In his physical examination was not found abdominal tenderness or rebound tenderness. The patient underwent laparotomy which revealed significant retroperitoneal adhesion and colostomy was reversed. Accidentally was found a dense structure with bone-like consistency in the abdominal wall close to the scar was resected. The specimen Pathologic examination showed metaplastic bone deposition with mature bone trabeculae and heterotopic ossification was confirmed. CONCLUSION We report a rare case of HO that was identified at the abdominal wall. Heterotopic ossification can lead to serious complications. However, in symptomatic patients, surgical excision is an acceptable treatment, unlike in asymptomatic patients.
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Affiliation(s)
- Mohadeseh Karimi
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Seyed Abdollah Mousavi
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Althaqafi RMM, Assiri SA, Aloufi RA, Althobaiti F, Althobaiti B, Al Adwani M. A case report and literature review of heterotopic mesenteric ossification. Int J Surg Case Rep 2021; 82:105905. [PMID: 33962265 PMCID: PMC8113807 DOI: 10.1016/j.ijscr.2021.105905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction and importance Heterotopic mesenteric ossification is a benign bony tissue growth in the mesentery that mostly follows repetitive or severe abdominal injuries leading to reactive bone formation in the mesentery. There are only 73 cases (51 publications) identified in the literature up to the beginning of 2020. Case presentation 45-year-old Saudi male underwent multiple laparotomies to manage complicated appendicitis which ended with a diverting ileostomy and a colostomy as a mucus fistula. After 9 months, the patient was admitted to the General Surgery department in Al-Hada Armed Forces Hospital for an open ileostomy and colostomy reversal surgery where several irregular bone-like tissues of hard consistency and sharp edges with some spindle-shaped structures resembling needles were found in the mesentery of the small intestine and histopathology revealed of trabecular bone fragments confirming the diagnosis. Clinical discussion The majority of cases occur mid to late adulthood with a predilection in the male gender, and usually present with bowel obstruction or an enterocutaneous fistula. Although it has no malignant potential, it may cause severe bowel obstruction that can lead to mortality, it's a rare occurrence and, therefore, is difficult to diagnose among many common abdominal disturbances. Conclusion Here we report a rare case of heterotopic mesenteric ossification, which should be considered as one of the delayed complications of abdominal surgery or trauma. The time range of expecting the presentation of heterotopic mesenteric ossification following major abdominal trauma or surgery should be extended and continuously considered during differential diagnosis.
One of the delayed complications of abdominal surgery or trauma is Heterotopic mesenteric ossification. Since 1983 there are only 73 cases of Heterotopic mesenteric ossification published to date. Preoperative diagnosis of Heterotopic mesenteric ossification should be based mainly on the characteristic radiographic findings without relying on the levels of calcium or alkaline phosphatase. The only way to reach the definitive diagnosis is through excision and histopathological analysis. Heterotopic mesenteric ossification has no malignant potential, but it can cause severe bowel obstruction that can lead to mortality in already sick patients.
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Affiliation(s)
| | | | | | - Fawaz Althobaiti
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Budur Althobaiti
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mohammad Al Adwani
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
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Andrea Aurelio R, Nicola DR, Stefani C, Francesco S, Alberto F, Anna Vittoria M, Roberta G. An unusual case of bowel obstruction in emergency surgery: The heterotopic mesenteric ossification. SAGE Open Med Case Rep 2020; 8:2050313X20926042. [PMID: 32637108 PMCID: PMC7323276 DOI: 10.1177/2050313x20926042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/16/2020] [Indexed: 12/05/2022] Open
Abstract
The heterotopic mesenteric ossification, also known as myositis ossificans, is a rare form of heterotopic ossification, a metaplastic phenomenon where new bone is formed in the mesenteric base, generally after abdominal trauma (surgical or other). The pathophysiology of heterotopic mesenteric ossification is unknown; clinical presentation is not specific, with vague abdominal symptoms, uncertain radiological findings, and often regular laboratory exams. No consensus exists on the best possible approach, although it might well be both medical and surgical. We reviewed the clinical history of a 28-year-old man with a recent motor vehicle accident who was admitted to our surgical unit with symptoms consistent with a small bowel obstruction; after surgery, a diagnosis of myositis ossificans was surprisingly made.
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Affiliation(s)
| | - De Ruvo Nicola
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Caramaschi Stefani
- Department of Maternal, Child and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Serra Francesco
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Farinetti Alberto
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Mattioli Anna Vittoria
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Gelmini Roberta
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
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Extensive Circumferential Heterotopic Ossification Discovered at the Base of a Loop Ileostomy. Case Rep Surg 2019; 2019:4036716. [PMID: 31886007 PMCID: PMC6914893 DOI: 10.1155/2019/4036716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/17/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
Heterotopic ossification is a rare phenomenon defined by the formation of bone within nonossifying soft tissues. A rare variant of heterotopic ossification is heterotopic mesenteric ossification (HMO), in which there is involvement of the mesentery and surrounding intra-abdominal structures. There are only four previously reported cases of HMO involving an ileostomy. We present a case of HMO affecting an ileostomy which was discovered during elective stoma reversal in a 52-year-old male who required fecal diversion following perineal necrotizing fasciitis.
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Multiple Heterotopic Ossification of the Intestine Detected by 99mTc-MDP Bone Scan in a Patient With Primary Peritoneal Cancer. Clin Nucl Med 2018; 43:749-751. [DOI: 10.1097/rlu.0000000000002234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Amalfitano M, Fyfe B, Thomas SV, Egan KP, Xu M, Smith AG, Kaplan FS, Shore EM, Pignolo RJ. A case report of mesenteric heterotopic ossification: Histopathologic and genetic findings. Bone 2018; 109:56-60. [PMID: 29320714 DOI: 10.1016/j.bone.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/06/2018] [Indexed: 02/08/2023]
Abstract
Mesenteric heterotopic ossification (MHO) is very rare and occurs in mid- to late-adulthood, usually in the context of prior abdominal surgery. The mechanisms of MHO are unknown. Here we describe the case of a 72-year-old man with MHO. Standard histological staining revealed that MHO occurred through an endochondral process. By comparison to known mutations in genetic conditions of HO such as fibrodysplasia ossificans progressiva (FOP) and progressive osseous heteroplasia (POH), DNA sequencing analysis demonstrated the presence of a commonly occurring heterozygous synonymous polymorphism (c.690G>A; E230E) in the causative gene for FOP (ACVR1/ALK2). However, no frameshift, missense, or nonsense mutations in ACVR1, or in the causative gene for POH (GNAS), were found. Although genetic predisposition may play a role in MHO, our data suggest that mutations which occur in known hereditary conditions of HO are not the primary cause.
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Affiliation(s)
- Matthew Amalfitano
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Billie Fyfe
- Department of Pathology and Laboratory Medicine, Rutgers - Robert Wood Johnson Medical School, Department of Pathology and Laboratory Medicine, United States
| | - Sumi V Thomas
- Department of Pathology and Laboratory Medicine, Rutgers - Robert Wood Johnson Medical School, Department of Pathology and Laboratory Medicine, United States
| | - Kevin P Egan
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Meiqi Xu
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Andrew G Smith
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Frederick S Kaplan
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Eileen M Shore
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Robert J Pignolo
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, United States.
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Ferreira C, Gomes C, Melo A, Tenreiro N, Pinto B, Moreira H, Ribeiro A, Avelar P. Heterotopic mesenteric and abdominal wall ossification - Two case reports in one institution. Int J Surg Case Rep 2017; 37:22-25. [PMID: 28623757 PMCID: PMC5475359 DOI: 10.1016/j.ijscr.2017.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Heterotopic ossification occurs when bone develops in tissues which usually don't undergo ossification. Heterotopic mesenteric ossification, also known as intra-abdominal myositis ossificans, is a rare and benign form of ossification, usually related with previous abdominal surgery or trauma. PRESENTATION OF CASES We report two cases of heterotopic ossification both after multiple abdominal surgeries, with intraoperative findings of mesenteric and abdominal wall ossification. Histopathology revealed metaplastic bone deposition, without evidence of atypia or malignancy. DISCUSSION This rare entity shares clinical and pathological characteristics of myositis ossificans. It is important to consider the differential diagnosis with sarcomas. In the cases described, the patients were proposed for elective surgery and this pathology was as an incidental finding. CONCLUSION The simultaneous presence of mesenteric and abdominal wall ossification in both patients makes these cases even rarer.
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Affiliation(s)
- Cátia Ferreira
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal.
| | - Carina Gomes
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Ana Melo
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Nádia Tenreiro
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Bruno Pinto
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Herculano Moreira
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Artur Ribeiro
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Paulo Avelar
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
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10
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Zamolyi RQ, Souza P, Nascimento AG, Unni KK. Intraabdominal Myositis Ossificans: A Report of 9 New Cases. Int J Surg Pathol 2016; 14:37-41. [PMID: 16501833 DOI: 10.1177/106689690601400107] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraabdominal myositis ossificans (IMO) is a rare benign disorder characterized by reactive bone formation in intraabdominal soft tissue that should be distinguished from a malignant condition. We retrospectively searched our patient records and report 9 new cases of IMO. The lesions occurred in 7 men and 2 women with a mean age of 50 years (range, 24-76 years), 5 of whom had previous abdominal surgery. Histologically, all the cases were similar, consisting of a reactive mesenchymal process in adipose tissue. Mitosis was observed, but with no atypical forms, and the lesions lacked malignant cytologic features. IMO is an uncommon benign lesion that develops relatively rapidly. The pathogenesis is related to intraabdominal surgical procedures, but the exact mechanism remains to be determined.
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Affiliation(s)
- Renata Q Zamolyi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, USA
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11
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Abstract
We present a case of a 26-year-old man with mesenteric heterotopic ossification following blunt abdominal trauma and multiple surgical operations. Computed tomography 10 months after the initial trauma demonstrated linear, branching opacities within the small bowel mesentery that had a cortical and trabecular structure indicative of mature bone. We found only 25 reports in the literature of small bowel mesentery heterotopic ossification. The significance of this non-neoplastic process is three-fold: (1) patients often present with bowel obstruction; (2) the process tends to worsen or reoccur after repeat laparotomy, and (3) rare forms of malignant neoplasms such as extraskeletal osteosarcoma may have a similar appearance.
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12
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Herrera-Toro N, Mejía-Sarasti FJ. Osificación mesentérica heterotópica en un niño: informe del caso. IATREIA 2015. [DOI: 10.17533/udea.iatreia.v29n1a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ectopic bone in the abdominal cavity: a surgical nightmare. J Gastrointest Surg 2013; 17:1708-11. [PMID: 23677432 DOI: 10.1007/s11605-013-2228-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/02/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Heterotopic mesenteric ossification (HMO) is a rare clinical entity with less than 40 reported cases in the literature. Frequently associated with prior abdominal surgery or trauma, the precise etiology and optimal approach to its management remain undefined. CASE REPORT The index patient is a 58-year-old male who originally presented with perforated diverticulitis. Following resection, the patient developed an enterocutaneous fistula. After a trial of conservative management, the patient underwent exploration and was found to have widespread intra-abdominal calcification. Sheets of calcific tissue were resected, and a diagnosis of HMO was confirmed via pathology. The patient had a postoperative course complicated by bleeding and redevelopment of enteric fistula. Following a prolonged hospital course requiring multiple operations, the fistula persists, and the patient remains on parenteral nutrition. DISCUSSION The etiology of HMO is unknown. Diagnosis requires a high degree of clinical suspicion, as radiologic findings are often misleading. A review of 18 cases demonstrates significant morbidity associated with operative intervention. Nonsteroidals, in particular indomethacin, have been shown to decrease heterotopic ossification, but their role in mesenteric disease is not clearly defined. CONCLUSION HMO is a rare but complicated pathologic process. A trial of conservative management with NSAIDs, bowel rest, and total parenteral nutrition is prudent, given the high rate of morbidity and mortality associated with operative intervention.
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Binesh F, Akhavan A, Navabii H, Ostadi M. Heterotopic mesenteric ossification: report of a case and review of the literature. BMJ Case Rep 2012; 2012:bcr0220125793. [PMID: 23045437 PMCID: PMC4543137 DOI: 10.1136/bcr-02-2012-5793] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heterotopic mesenteric ossification (HMO) is a distinct intra-abdominal ossifying pseudotumour that typically occurs in men, almost always after surgery or abdominal trauma, and frequently presents with symptoms of intestinal obstruction. We herein describe a case of HMO occurring in a 42-year-old Iranian man with a history of abdominal blunt trauma. He underwent partial small intestinal and its mesentery resection. The postoperative course was uneventful. Now he is in good condition after 6 months.
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Affiliation(s)
- Fariba Binesh
- Department of Pathology, Yazd Shahid Sadoughi University, Yazd, Iran, Islamic Republic of Iran.
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15
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Ruiz Carazo E, Culiáñez Casas M, Guzmán Álvarez L. Osteosarcoma extraesquelético mesentérico primario: hallazgos en imagen. RADIOLOGIA 2012; 54:366-9. [DOI: 10.1016/j.rx.2010.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/15/2010] [Accepted: 09/21/2010] [Indexed: 11/15/2022]
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Bone in the belly: traumatic heterotopic mesenteric ossification. Emerg Radiol 2012; 19:429-36. [PMID: 22527357 DOI: 10.1007/s10140-012-1042-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
Heterotopic mesenteric ossification is an unusual but important complication in patients who sustain blunt and penetrating abdominal trauma. In this condition, bone formation occurs in the mesenteric and omental fat in response to injury and may result in serious complications such as bowel obstruction and fistula formation. Although a few case reports exist, the radiology literature on this topic is scant. Based on our experience, this entity is under-recognized on imaging studies and often results in diagnostic confusion due to its resemblance to other pathologies such as barium leak and extraskeletal bone-forming neoplasms. This review highlights the imaging features of heterotopic mesenteric ossification with an emphasis on computed tomographic findings. Radiologist awareness of this condition is crucial to avoid misdiagnosis as well as to direct appropriate and timely management.
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Reynoso JF, Christensen D, Latifi R. Heterotopic mesenteric ossification as a cause of persistent enterocutaneous fistula: overview of the literature and addition of a new case*. Eur Surg 2011. [DOI: 10.1007/s10353-011-0020-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Shi X, Zhang W, Nabieu PF, Zhao W, Fu C. Early postoperative heterotopic omental ossification: report of a case. Surg Today 2010; 41:137-40. [PMID: 21191707 DOI: 10.1007/s00595-009-4213-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 12/17/2009] [Indexed: 11/26/2022]
Abstract
Heterotopic mesenteric ossification (HMO) is an uncommon disorder that may sometimes be misdiagnosed. It can cause bowel or intestinal perforation, which may also lead to serious complications or even death. Heterotopic bone formation in the omentum, which is called heterotopic omental ossification (HOO) and is one type of HMO, is considered to be an exceedingly rare event. To our knowledge, about 29 cases of HMO have been reported in previous studies, of which three were HOO. We herein describe a case of HOO occurring in a 39-year-old Chinese man with no medical history of abdominal surgery. He underwent a left hemicolectomy, which was performed for the treatment of descending colon adenocarcinoma. Two weeks later, he developed a small bowel obstruction associated with multiple foci of heterotopic bone formation within the omentum. He therefore underwent a second surgical procedure for adhesiolysis and a partial omentectomy. The postoperative course was uneventful. He is still alive and disease-free 16 months later.
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Affiliation(s)
- Xiaohui Shi
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, No 168 Changhai Road, Shanghai 200433, PR China
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Heterotopic Mesenteric Ossification Following Gastric Bypass Surgery: Case Series and Review of Literature. Obes Surg 2010; 20:1312-5. [DOI: 10.1007/s11695-009-0072-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 12/30/2009] [Indexed: 11/27/2022]
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Levy AD, Shaw JC, Sobin LH. Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation. Radiographics 2009; 29:347-73. [PMID: 19325052 DOI: 10.1148/rg.292085189] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tumors and tumorlike lesions that secondarily involve the mesothelial or submesothelial layers of the peritoneum are a diverse group of disorders that range in biologic behavior from benign to highly malignant. The anatomy of peritoneal ligaments and mesenteries and the normal circulation of peritoneal fluid dictate location and distribution of these diseases within the peritoneal cavity. Peritoneal carcinomatosis is the most common secondary tumor to affect the peritoneal cavity. When it arises from carcinomas of the gastrointestinal tract or ovary, the prognosis is grave. However, when low-grade mucinous adenocarcinoma of the appendix spreads to the peritoneal cavity, the consequence is typically pseudomyxoma peritonei, which is a clinical syndrome, characterized by recurrent and recalcitrant voluminous mucinous ascites due to surface growth on the peritoneum without significant invasion of underlying tissues. Carcinomas from elsewhere in the body, as well as lymphomas and sarcomas, may also produce diffuse peritoneal metastasis. Granulomatous peritonitis is the consequence of disseminated infection such as tuberculosis or histoplasmosis, foreign materials, or rupture of a tumor or hollow viscus. Finally, a group of benign miscellaneous conditions that range from common disorders such as endometriosis and splenosis to very rare conditions such as gliomatosis peritonei and melanosis may also affect the peritoneum diffusely. Secondary tumors and tumorlike lesions of the peritoneum have overlapping imaging features when compared with each other and primary peritoneal tumors. Knowledge of peritoneal anatomy, normal fluid circulation within the peritoneal cavity, and clinical and pathologic features of secondary peritoneal lesions is essential for identification of these lesions.
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Affiliation(s)
- Angela D Levy
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
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Imaging characteristics of heterotopic mesenteric ossification on FDG PET and Tc-99m bone SPECT. Clin Nucl Med 2008; 33:496-9. [PMID: 18580241 DOI: 10.1097/rlu.0b013e31817793d1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A CT scan of a 69-year-old male patient, performed for staging of suspected lung carcinoma, incidentally showed an irregular lesion of 10 cm in the upper abdomen. Further investigation using FDG-PET showed only moderately increased glucose metabolism, whereas Tc-99m MDP SPECT revealed intense osteoblastic activity inside the lesion. A CT-guided biopsy was performed and histologic analysis established the diagnosis of heterotopic mesenteric ossification. This pathology is rare and mostly diagnosed when it is complicated by small bowel obstruction.
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Lai HJ, Jao SW, Lee TY, Ou JJ, Kang JC. Heterotopic Mesenteric Ossification After Total Colectomy for Bleeding Diverticulosis of the Colon—A Rare Case Report. J Formos Med Assoc 2007; 106:S32-6. [PMID: 17493894 DOI: 10.1016/s0929-6646(09)60350-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Heterotopic bone formation within an abdominal incision is a rare sequela of abdominal surgery. Only a few previous reports have noted heterotopic ossification in the mesentery of the small intestine and peri-ileostomy. Here, we report the case of a 60-year-old man who underwent emergent laparotomy and total colectomy with end ileostomy and developed this condition 1 month postoperatively. Heterotopic ossification in the peri-ileostomy tissue caused stenosis of the ileostoma. Laparotomy for re-anastomosis due to a large bone formation at an abdominal midline scar is very difficult and results in a massive abdominal wall defect. Therefore, we used a lower transverse incision to avoid the site of bone formation and resected the terminal ileum with its ossified mesentery. Then, we successfully carried out an anastomosis between the ileum and the rectum. The possible pathogenesis is a metaplastic mechanism of differentiation of immature multipotent mesenchymal cells. Our case provides the experience of treatment and new perspective on currently held hypotheses of heterotopic bone formation.
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Affiliation(s)
- Huang-Jen Lai
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
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Gouëllo JP, Auvray L, Bouix A, Vazelle F, Guinard N, Hermes D. Early post-traumatic heterotopic mesenteric ossification: report of a case. Intensive Care Med 2006; 32:950-1. [PMID: 16568275 DOI: 10.1007/s00134-006-0144-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2006] [Indexed: 10/24/2022]
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Hüser N, Stangl M, Lutz J, Fend F, Kreymann B, Gaa J. Sclerosing encapsulating peritonitis: MRI diagnosis. Eur Radiol 2005; 16:238-9. [PMID: 15821944 DOI: 10.1007/s00330-005-2746-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 02/07/2005] [Accepted: 02/25/2005] [Indexed: 11/24/2022]
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