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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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2
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Soltani H, Faraji F, Khabiri S, Davoodzadeh M, Hashemi SH, Bagherpour JZ. A case report of heterotopic ossifications in abdominal incision scar. Int J Surg Case Rep 2024; 119:109655. [PMID: 38704967 PMCID: PMC11074967 DOI: 10.1016/j.ijscr.2024.109655] [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: 02/14/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Heterotopic ossification (HO) develops when bone formation appears in soft tissues, usually after an injury or major surgery. Timely and accurately diagnosing of this rare event is essential due to the possibility of misdiagnosis as a maintained foreign body, infection, incisional neoplastic recurrence, and metastatic or primary neoplasms. CASE PRESENTATION In this study, we present a 57-year-old man who was operated for peritonitis due to perforated appendicitis, and an asymptomatic HO was accidentally found on an incisional line of previous open prostatectomy about 5 years earlier due to benign prostatic hyperplasia. A bone density lesion was seen in the fascia and on the incisional scar of previous surgery. DISCUSSION HO rarely occurs within an abdominal incision due to surgery. It is reported only within vertical midline incisions and mainly within the first year after the operation. Imaging confirms the diagnosis of HO in previous abdominal surgery scars, which reveals dense vertical calcification along the previous incisional scar. In the case of HO, the exclusive effective management is the entire surgical excision with primary closure, and NSAIDs are the preventive choices. CONCLUSION HO should be considered in patients presenting with discomfort or palpable mass or even asymptomatic patients with previous abdominal surgeries besides considering relative history such as surgical complications or neoplasms.
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Affiliation(s)
- Hedieh Soltani
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Faraji
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Saba Khabiri
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mona Davoodzadeh
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyedeh Hamideh Hashemi
- Department of Anesthestetics, Shahid Madani Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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3
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Lee SS. Post-laparotomy heterotopic ossification of the xiphoid process: A case report. World J Clin Cases 2023; 11:8568-8573. [PMID: 38188202 PMCID: PMC10768515 DOI: 10.12998/wjcc.v11.i36.8568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Heterotopic ossification (HO) represents all types of extraskeletal ossification in the body. It occurs in various areas, including the skin, subcutaneous tissue, muscle, and joints. Surgical excision is recommended for symptomatic HO. Postoperative radiotherapy, oral nonsteroidal anti-inflammatory drugs, and topical sealants, such as bone wax, have been recommended as preventive measures. As HO is rare in occurrence, these recommendations are based on personal experiences, and there is a lack of information on individualized treatments depending on its location. CASE SUMMARY A 62-year-old male was admitted for symptomatic HO along a laparotomy scar. Surgical excision was performed for an 11 cm-sized ossification originating from the xiphoid process, and bone wax was applied to the excisional margin. However, the surgical wound failed to heal. After several weeks of saline-soaked gauze dressing, delayed wound closure was performed. The patient was finally discharged eight weeks after the excision. Because HO can occur in various areas of the body, a treatment strategy that may be effective for some may not be for others. Bone wax has been used as a topical sealant over excisional margins in the shoulder, elbow, and temporomandibular joints. However, in our case, its application on an abdominal surgical wound delayed its primary healing intention. The valuable lesson was that, when choosing a treatment method for HO based on available research data, its location must be considered. CONCLUSION Complete excision should be the priority treatment option for symptomatic HO along the laparotomy scar. Bone wax application is not recommended.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital, Daegu 41944, South Korea
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
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4
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Louis EM, Nicolaou S. Bowel obstruction and perforation secondary to progressive heterotopic mesenteric ossificans. Radiol Case Rep 2022; 17:3651-3654. [PMID: 35936874 PMCID: PMC9352512 DOI: 10.1016/j.radcr.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 12/03/2022] Open
Abstract
Heterotopic mesenteric ossification (HMO) is a rare condition which usually affects male patients. Its defining feature is hyperdense ossification in the mesentery, usually following surgery or trauma. Due to potentially serious complications that can arise from HMO, it is essential to recognize it in its nascent stages. In this case study, a 65-year-old male was imaged by CT scan serially over several years for recurrent bowel obstruction as a result of worsening HMO, providing new insight into the natural progression of this condition. Mechanical injury of the bowel eventually caused perforation and abscess formation.
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5
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Martinbianco EM, Lilley CM, Grech J, Mirza KM, Chen X. Heterotopic Mesenteric Ossification With Trilineage Hematopoiesis. Cureus 2022; 14:e24620. [PMID: 35664416 PMCID: PMC9150764 DOI: 10.7759/cureus.24620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/05/2022] Open
Abstract
Heterotopic ossification (HO) histologically refers to extraskeletal bone formation in non-ossifying tissues, most commonly noted in the extremities, buttocks, abdominal wall, and hip joints. HO developing in the mesentery (heterotopic mesenteric ossification, HMO) is very rare, with fewer than 100 cases reported in the literature. It usually occurs in adult male patients with a history of repeated abdominal trauma. So far, only two cases of HMO have been reported with the development of hematopoietic bone marrow. Here, we report the third case of HMO with true trilineage hematopoiesis in a 66-year-old female with suspicious mesenteric-retained foreign material from prior surgical procedures, including hysterectomy for endometrial adenocarcinoma and multiple repairs for incisional hernia.
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6
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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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7
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Di Paolo N, Sacchi G, Lorenzoni P, Sansoni E, Gaggiotti E. Ossification of the Peritoneal Membrane. Perit Dial Int 2020. [DOI: 10.1177/089686080402400513] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BackgroundPeritoneal dialysis (PD) patients rarely develop sclerosing peritonitis (SP), a severe, life-threatening condition of unknown pathogenesis. Ossification of the peritoneum (PO) is a rare occurrence, which has, however, been reported in PD patients with SP.ObjectiveTo investigate etiopathogenetic correlations between PO and SP by histopathological examination.MethodWe examined biopsy specimens, obtained by laparoscopy or during surgery from 36 patients with SP, from all parts of Italy in the past 8 years for evidence of peritoneal calcification or ossification. Other studies were performed on a sample of dense white material found under the parietal peritoneum of 1 patient during laparoscopy.ResultsOssification of the peritoneum was found in 4/16 patients with calcifications. In addition to PO, we also found bone marrow in two specimens and arterial ossification in one case. In specimens with calcifications, and especially those with ossification, there was evidence of peritoneal inflammation with infiltration of lymphocytes, multinuclear giant cells, macrophages, and mast cells. The chemical composition of the whitish material was 85% calcium chloride and 15% hydroxyapatite.ConclusionsCalcifications alone were found in 33% (12/36) of cases of SP; 11% of SP cases were complicated by both peritoneal calcification and ossification (4/36), which indicates great availability of calcium under conditions of inflammation. Where does this calcium come from? In 1 patient with PO, the quantity of calcium was enormous and its unusual composition suggested a link with the calcium contained in dialysis solution.
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Affiliation(s)
- Nicola Di Paolo
- Department of Nephrology and Dialysis, University Hospital, Siena, Italy
| | - Giovanni Sacchi
- Neuroscience Department, Molecular Medicine Section, University of Siena, Siena, Italy
| | - Paola Lorenzoni
- Neuroscience Department, Molecular Medicine Section, University of Siena, Siena, Italy
| | - Enrico Sansoni
- Department of Nephrology and Dialysis, University Hospital, Siena, Italy
| | - Enzo Gaggiotti
- Department of Nephrology and Dialysis, University Hospital, Siena, Italy
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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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9
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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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10
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Bovo G, Romano F, Perego E, Franciosi C, Buffa R, Uggeri F. Heterotopic Mesenteric Ossification (“Intraabdominal Myositis Ossificans”): A Case Report. Int J Surg Pathol 2016; 12:407-9. [PMID: 15494869 DOI: 10.1177/106689690401200416] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heterotopic ossification has been reported only rarely within the abdominal cavity, specifically in a mesenteric location (heterotopic mesenteric ossification). We describe the case of a 76-year-old man with no history of previous surgery who developed small bowel obstruction associated with multiple foci of heterotopic bone formation within the small bowel mesentery. He underwent small bowel and mesentery resection and is disease-free 9 months later.
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Affiliation(s)
- Giorgio Bovo
- Division of Pathology, San Gerardo Hospital, II University of Milan-Bicocca, Italy
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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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Heterotopic mesenteric ossification after a ruptured abdominal aortic aneurism: case report with a review of literatures. Int Surg 2015; 99:479-84. [PMID: 25058788 DOI: 10.9738/intsurg-d-13-00074.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Heterotopic mesenteric ossification (HMO) is a rare disease that results in intra-abdominal ossification of unknown origin. An 88-year-old man developed an intestinal obstruction 2 weeks after undergoing an operation for a ruptured abdominal aortic aneurysm, resulting in intestinal obstructions those did not improved concervatively. During relaparotomy performed 30 days after the first operation, hard adhesions of the small intestine and mesentery were found; these adhesions were difficult to separate without damaging the serosa of the small intestine. We removed 240 cm of the small intestine and performed a jejuno-ileo anastomosis. Microscopically, trabecular bone tissue had increased irregularly in the fat tissue of the nodules with fibrosis, which were partially lined with osteoblasts. Accordingly, we histopathologically diagnosed the patient as having HMO. The patient was treated with NSAIDs and cimetidine to prevent the recurrence of HMO. No signs of recurrence have occurred as of one year after the second operation.
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Hicks CW, Velopulos CG, Sacks JM. Mesenteric calcification following abdominal stab wound. Int J Surg Case Rep 2014; 5:476-9. [PMID: 24981165 PMCID: PMC4147645 DOI: 10.1016/j.ijscr.2014.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/28/2014] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Heterotopic ossification (HO) refers to the formation of bone in non-ossifying tissue. Heterotopic mesenteric ossification is a rare form of HO that is characterized by the formation of an ossifying pseudotumour at the base of the mesentery, usually following abdominal surgery. PRESENTATION OF CASE We describe a case of mesenteric HO in a young male who presented for elective ventral incisional hernia repair following a stab wound to the abdomen requiring exploratory laparotomy 21 months earlier. Preoperative workup was unremarkable, but a hard, bone-like lesion was noted to encircle the base of the mesentery upon entering the abdomen, consistent with HO. The lesion was excised with close margins, and his hernia was repaired without incident. DISCUSSION Traumatic HO describes the ossification of extra-skeletal tissue that specifically follows a traumatic event. It usually occurs adjacent to skeletal tissue, but has been occasionally described in the abdomen as well, usually in patients who suffer abdominal trauma. Overall the prognosis of HO is good, as it is considered a benign lesion with no malignant potential. However, the major morbidity associated with mesenteric HO is bowel obstruction. CONCLUSION The size, location, and symptoms related to our patient's mesenteric HO put him risk for obstruction in the future. As a result, the mass was surgically excised during his ventral hernia repair with good outcomes.
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Affiliation(s)
- Caitlin W Hicks
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Catherine G Velopulos
- Department of General Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, United States.
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14
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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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15
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Hogan NM, Caffrey E, Curran S, Sheehan M, Joyce MR. Heterotopic ossification of the abdominal wall. Int J Surg Case Rep 2012; 3:489-91. [PMID: 22858788 DOI: 10.1016/j.ijscr.2012.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Heterotopic ossification is a rare, benign condition which occurs when bone develops in tissues that do not normally ossify. PRESENTATION OF CASE We herein report the case of a 73-year-old gentleman who underwent a laparotomy for a large splenic flexure tumour considered unresectable at initial intervention. Following delivery of chemotherapy, he was referred for a second opinion and the tumour with adjacent structures was removed at a subsequent laparotomy. A segment of abnormal hard tissue present in the abdominal wall was also excised. Histopathology revealed metaplastic bone deposition. DISCUSSION Heterotopic ossification may occur at various sites and is a recognised but exceedingly infrequent sequela of abdominal surgery. CONCLUSION This case highlights clinical, aetiological and histopathological features of this rare finding.
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Affiliation(s)
- Niamh M Hogan
- Department of Colorectal Surgery, University College Hospital Galway, Galway, Ireland
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16
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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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17
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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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18
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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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Gayer G, Petrovitch I, Jeffrey RB. Foreign objects encountered in the abdominal cavity at CT. Radiographics 2011; 31:409-28. [PMID: 21415187 DOI: 10.1148/rg.312105123] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Foreign objects are not infrequently seen at computed tomography (CT) of the abdomen and pelvis and may pose a diagnostic challenge to the radiologist, who must recognize the object, characterize its nature and location, and determine its clinical significance. Most foreign objects are incidentally detected at CT, but they may mimic a wide range of pathologic conditions. Some foreign objects (eg, an object that has been swallowed either intentionally or unintentionally) are the cause of the patient's signs and symptoms and require prompt medical attention. Other objects, such as a sponge or surgical instrument that has been retained postoperatively, may have medicolegal consequences. Furthermore, certain objects, such as intentionally concealed drug packets, may go undetected unless a high degree of suspicion exists and appropriate window settings are used to review the study. The radiologist should be familiar with the wide range of foreign objects that may be encountered at abdominopelvic CT, be able to recognize them promptly, and understand their implications for patient treatment.
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Affiliation(s)
- Gabriela Gayer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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20
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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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21
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22
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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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23
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Hayashi H, Takamura H, Nakamura K, Fujita H, Ninomiya I, Nishimura G, Fujimura T, Kayahara M, Ota T. A Case of Heterotopic Mesenteric Ossification after Multiple Pelvic Bone Fracture. ACTA ACUST UNITED AC 2009. [DOI: 10.5833/jjgs.42.1621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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25
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Liu K, Tripp S, Layfield LJ. Heterotopic ossification: Review of histologic findings and tissue distribution in a 10-year experience. Pathol Res Pract 2007; 203:633-40. [PMID: 17728073 DOI: 10.1016/j.prp.2007.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 02/09/2007] [Accepted: 05/24/2007] [Indexed: 10/22/2022]
Abstract
Heterotopic ossification (HO) within tissues involved by a pathologic process is a well-recognized phenomenon. It is most frequently observed in atherosclerotic plaques, in soft tissue around joints, and in the central nervous system. Less frequently, carcinomas and some benign neoplasms will undergo heterotopic ossification. We performed a retrospective review of our experience with HO over a 10-year period to determine the frequency and tissue site distribution of heterotopic ossification. A computerized review of surgical pathology records of approximately 126,000 reports revealed 85 cases in which heterotopic ossification, ectopic bone or metaplastic bone was specifically mentioned in the surgical pathology diagnosis. Twenty-two cases were neoplasms of non-osseous tissues, and 63 cases were non-neoplastic lesions. Immunohistochemical staining for bone morphogenic proteins (BMP) 1, 4, and 6 was performed. Fourteen cases showed staining for BMP-1, 22 cases showed staining for BMP-4, and five cases showed weak staining for BMP-6. HO is a relatively infrequent finding and is more commonly seen in degenerative and reparative conditions than in neoplasms.
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Affiliation(s)
- Katharine Liu
- Department of Pathology, University Hospital, Augusta, GA, USA
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26
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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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Abstract
We report a case of heterotopic bone formation in the mesentery. A 64-year-old man presented with abdominal pain and stiffness two months after undergoing several surgical interventions for hemorrhagic colitis. The diagnosis was heterotopic mesenteric ossification. We describe the imaging findings and review the literature.
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Affiliation(s)
- S Ibáñez Alonso
- Servicio de Radiodiagnóstico, Hospital de Cruces, Baracaldo, Vizcaya, España.
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28
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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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Abstract
An autopsy of a 72-year-old white male revealed a 30.5 x 5.1 cm vertically aligned heterotopic ossification just deep to a 30.5 cm midline abdominal scar. The ossified mass was determined to be a heterotopic ossification or myostitis ossificans (MO) traumatica resulting from an abdominal surgical incision during life. While, MO traumatica is relatively common accounting for roughly 60-75% of patients with soft-tissue ossification, heterotopic ossification of abdominal incisions are relatively rare and thus infrequently reported. This article details the manifestation of this relatively large heterotopic bone and provides a comprehensive review of the literature and pathogenesis of this unusual ossification. A review of the English literature from 1920 to the present produced only a handful of articles for a total of 185 reported cases. All had bone formed within vertical incisions, usually within 1 year of surgery, and 89% were males. Knowledge of this phenomenon and the variable size at presentation is useful to both the autopsy pathologist and the anthropologist in generating a diagnosis for abnormal calcifications.
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Affiliation(s)
- Alaina K Goff
- Department of Anthropology, MSC01 1050, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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30
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Patel RM, Weiss SW, Folpe AL. Heterotopic mesenteric ossification: a distinctive pseudosarcoma commonly associated with intestinal obstruction. Am J Surg Pathol 2006; 30:119-22. [PMID: 16330951 DOI: 10.1097/01.pas.0000184820.71752.20] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heterotopic mesenteric ossification (HMO) is a rare intraabdominal bone-producing pseudosarcoma with fewer than 14 reported cases in the literature. We report our experience with 6 additional cases, all of which were referred to us with a diagnostic consideration of extraskeletal osteosarcoma (EO) or "sarcoma" and emphasize features which distinguish HMO from EO. Six intraabdominal lesions coded as "heterotopic mesenteric ossification," "ossifying pseudotumor," or "reactive myofibroblastic proliferation with ossification" were retrieved from our consultation files. Clinical follow-up information was obtained. Lesions occurred exclusively in males, with a mean patient age of 49 years (range, 22-72 years). The tumors occurred in the mesentery (N = 4), omentum (N = 1), or both (N = 1) and were preceded by significant abdominal surgery (4 cases) or trauma (1 case) in all but 1 case. Five patients presented with bowel obstruction and 1 with abdominal sepsis. Tumors were difficult to precisely measure; the mean size of the resection specimens was 11.8 cm (range, 3.5-20 cm). Grossly, the tumors resembled fat necrosis and often cut with a gritty sensation. Microscopically, all lesions demonstrated an exuberant, reactive (myo)fibroblastic proliferation resembling nodular fasciitis, with extensive hemorrhage and fat necrosis. All tumors produced abundant bone and osteoid, often "lace-like," and 2 contained cartilage. The proliferating (myo)fibroblasts, osteoblasts, and chondroblasts were mitotically active but cytologically bland. Follow-up (4 cases; mean, 47.3 months; range, 5-120 months) showed 3 patients alive without disease and 1 dead of unrelated causes. One case was recent. HMO is a distinct intraabdominal ossifying pseudotumor that typically occurs in males, almost always after surgery or abdominal trauma, and frequently presents with symptoms of intestinal obstruction. This clinical history, presence of clearly reactive zones resembling nodular fasciitis, thick osteoid, and absence of nuclear atypia, necrosis, and atypical mitotic figures allow the distinction of HMO from its most important morphologic mimic, EO.
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Affiliation(s)
- Rajiv M Patel
- Department of Pathology and Laboratory Medicine, 1364 Clifton Road NE, Emory University, Atlanta, GA 30222, USA
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