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Ectopic bone in the abdominal cavity: a surgical nightmare
Zachary Torgersen1, Angela Osmolak, Jai Bikhchandani
1Department of Surgery, Creighton University, 601 N 30th St Suite 3700, Omaha, NE 68131, USA. zacharytorgersen@creighton.edu
Summary
Heterotopic mesenteric ossification (HMO) is a rare condition often linked to abdominal surgery. Conservative management with NSAIDs and nutritional support is recommended due to high surgical morbidity.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Pathology
Background:
- Heterotopic mesenteric ossification (HMO) is a rare condition with fewer than 40 reported cases.
- Etiology and optimal management of HMO remain undefined.
- HMO is frequently associated with prior abdominal surgery or trauma.
Observation:
- A 58-year-old male with perforated diverticulitis developed an enterocutaneous fistula post-resection.
- Exploration revealed widespread intra-abdominal calcification, confirmed as HMO.
- The patient experienced significant postoperative complications, including persistent fistula and need for parenteral nutrition.
Findings:
- Diagnosis of HMO requires high clinical suspicion, as imaging can be misleading.
- Review of 18 cases indicates significant morbidity associated with surgical intervention for HMO.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), like indomethacin, may reduce heterotopic ossification.
Implications:
- HMO is a rare, complex pathology with high morbidity and mortality.
- Conservative management, including NSAIDs, bowel rest, and TPN, is a prudent initial approach.
- Further research is needed to define the role of NSAIDs in mesenteric ossification.
