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Published on: August 6, 2015
A case report and literature review of heterotopic mesenteric ossification
Raad M M Althaqafi1, Sara Ahmad Assiri1, Rawan Abdulrahman Aloufi2
1College of Medicine, Taif University, Taif, Saudi Arabia.
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.
Insights
Heterotopic mesenteric ossification is a rare benign bone growth in the mesentery, often following abdominal surgery or trauma. This case highlights its potential as a delayed complication requiring consideration in differential diagnoses.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Pathology
- Abdominal Imaging
Background:
- Heterotopic mesenteric ossification (HMO) is a rare benign condition characterized by bone formation within the mesentery.
- It is typically associated with prior abdominal trauma or surgery, leading to reactive bone formation.
- Literature review up to early 2020 identified only 73 cases in 51 publications.
Purpose of the Study:
- To report a rare case of heterotopic mesenteric ossification.
- To emphasize HMO as a potential delayed complication of abdominal interventions.
- To highlight the importance of considering HMO in the differential diagnosis of abdominal disturbances.
Main Methods:
- A case presentation of a 45-year-old male with complicated appendicitis requiring multiple laparotomies and ostomies.
- Surgical findings during ostomy reversal revealed irregular, hard, bone-like tissues in the mesentery.
- Histopathological examination confirmed the presence of trabecular bone fragments, diagnosing heterotopic mesenteric ossification.
Main Results:
- The patient presented with heterotopic mesenteric ossification nine months after initial surgery.
- Histopathology confirmed the diagnosis of ossification in the mesenteric tissue.
- The findings align with the known association of HMO with abdominal trauma and surgery.
Conclusions:
- Heterotopic mesenteric ossification is a rare but significant delayed complication of abdominal surgery or trauma.
- The diagnostic window for HMO should be considered broader than previously assumed.
- Continuous consideration of HMO in differential diagnoses is crucial for timely and accurate patient management.
