Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2023; 14(5): 362-368
Published online May 18, 2023. doi: 10.5312/wjo.v14.i5.362
Intra-abdominal myositis ossificans - a clinically challenging disease: A case report
Gabriele Carbone, Valentina Andreasi, Paola De Nardi
Gabriele Carbone, Valentina Andreasi, Paola De Nardi, Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Milan 20132, Italy
Author contributions: Carbone G and De Nardi P contributed to manuscript writing and editing, and data collection; Andreasi V contributed to data collection and conceptualization; all authors have read and approved the final manuscript.
Informed consent statement: The patient provided informed written consent for the use of his data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paola De Nardi, FASCRS, MD, Staff Physician, Surgeon, Department of Gastrointestinal Surgery, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan 20132, Italy. denardi.paola@hsr.it
Received: January 16, 2023
Peer-review started: January 16, 2023
First decision: January 31, 2023
Revised: February 25, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: May 18, 2023
Processing time: 122 Days and 2 Hours
Abstract
BACKGROUND

Myositis ossificans (MO) is an uncommon disorder characterized by heterotopic ossification within soft tissues. Only a few cases of intra-abdominal MO (IMO) have been described in the literature. Histology could be difficult to understand and a wrong diagnosis could lead to an improper cure.

CASE SUMMARY

We herein report the case of IMO in a healthy 69-year-old man. The patient presented with an abdominal mass in the left lower quadrant. A computed tomography scan showed an inhomogeneous mass with multiple calcifications. The patient underwent radical excision of the mass. Histopathological findings were compatible with MO. Five months later the patient showed a recurrence causing hemorrhagic shock due to intractable intralesional bleeding. The patients eventually died within three months since recurrence.

CONCLUSION

The case described could be classified as post-traumatic MO that developed close to the previously fractured iliac bone. The subsequent surgical procedure was ineffective and the disease rapidly recurred. The misleading intraoperative diagnosis led to improper surgical treatment with a dramatic evolution.

Keywords: Myositis ossificans; Post-traumatic; Diagnosis; Surgical treatment; Prognosis; Case report

Core Tip: Myositis ossificans (MO) is a rare condition of heterotopic bone formation within muscle or soft tissues. Intra-abdominal MO is even rarer usually arousing following abdominal surgery or trauma. Its presentation is non-specific and physical examination is usually unremarkable until the mass reaches large dimensions. Laboratory examinations are within normal limits. Computed tomography scan is essential for the diagnosis, since it can show the typical “zonal patterns” of the calcifications. Histopathology can differentiate MO from infections and malignancies. However, histology could be misinterpreted for fibromatosis or sarcoma, thus leading to improper cure. The treatment may be complex and should be based on patients’ symptoms. Most patients can be treated conservatively and surgical procedures should be reserved for selected patients since repetitive surgery promotes further and more aggressive calcifications.