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Spontaneous heterotopic mesenteric ossification around the pancreas causing duodenal stenosis: A case report with
Hanlim Choi1, Jae-Woon Choi1, Dong Hee Ryu1
1Department of Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
Introduction And Importance:
Heterotopic mesenteric ossification (HMO) is a rare condition that can be hereditary or nonhereditary. It can lead to small bowel obstruction, which may require corrective surgery. Most affected patients have a history of abdominal surgery or trauma. Spontaneously occurring HMO is even rarer, with only 7 cases reported till date. There has been no previous report of spontaneous peripancreatic HMO.
Case Presentation:
A 60-year-old man presented with complaints of recurrent nausea and vomiting for 2 months. Esophagogastroduodenoscopy revealed luminal stenosis and edematous changes involving the second and third parts of the duodenum but not its complete obstruction. Abdominopelvic computed tomography showed faintly enhanced thickening of the involved duodenal walls along with mild dilatation of the common bile duct. Considering the possibility of periampullary cancer, we performed a pylorus-preserving pancreaticoduodenectomy. Histopathological examination confirmed the diagnosis of HMO with extensive fibrosis involving the peripancreatic soft tissue.
Clinical Discussion:
The peripancreatic HMO with severe fibrosis can occur duodenal stenosis, and it is mimicking periampullary cancer. However, the preoperative diagnosis of spontaneous HMO is difficult, and a diagnosis confirmed after surgery.
Conclusion:
Herein, we described our experience of managing a rare case of duodenal stenosis due to spontaneous HMO involving peripancreatic tissue.
Insights
Heterotopic mesenteric ossification (HMO) is a rare condition. This report details a unique case of spontaneous peripancreatic HMO causing duodenal stenosis, a presentation not previously documented.
Area of Science:
- Gastroenterology
- Pathology
- Surgical Oncology
Background:
- Heterotopic mesenteric ossification (HMO) is a rare condition, often associated with prior abdominal surgery or trauma.
- Spontaneous occurrence of HMO is exceptionally rare, with limited reported cases.
- Peripancreatic HMO has not been previously documented.
Observation:
- A 60-year-old male presented with symptoms suggestive of duodenal stenosis, including nausea and vomiting.
- Imaging revealed duodenal wall thickening and mild common bile duct dilatation, raising suspicion for periampullary cancer.
- Surgical intervention (pylorus-preserving pancreaticoduodenectomy) was performed due to suspected malignancy.
Findings:
- Histopathological examination confirmed heterotopic mesenteric ossification (HMO) with extensive peripancreatic fibrosis.
- The condition mimicked periampullary cancer due to duodenal stenosis and associated fibrosis.
- This represents the first reported case of spontaneous peripancreatic HMO.
Implications:
- Spontaneous peripancreatic HMO can lead to duodenal stenosis, clinically mimicking malignancy.
- Preoperative diagnosis of spontaneous HMO is challenging, often requiring surgical confirmation.
- This case expands the known spectrum of HMO presentations and highlights the importance of considering rare diagnoses.
