Heterotopic intra-abdominal ossification in a complex ventral hernia defect

Heterotopic ossification, an entity common in orthopaedic practice frequently involving the hip, knee or other joints, is rarely encountered in abdominal wounds and mesentery. This unusual condition, referred to as mesenteric ossification, is typically associated with intra-abdominal catastrophes. Surgical repair following such catastrophes has always been a challenge as the abdominal wall architecture is frequently distorted by the multiple laparotomies previously performed. In addition, the presence of several enterocutaneous fistulae further compounds the reconstruction approach, especially when mesh material is planned for use. We report a case of intra-abdominal heterotopic ossification with mesenteric involvement after a penetrating injury to the abdomen, followed by multiple laparotomies that ended in a complex abdominal wall hernia with major loss of domain, and multiple enterocutaneous fistulae. The patient was treated with resection of the bony deposits from the abdominal wound and cavity, along with excision of the fistula sites. This was followed by a component separation technique and the use of a biologic mesh graft to reconstruct the abdominal wall.