A case report and literature review of heterotopic mesenteric ossification

Abstract

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.

Laparoscopic Enterolysis of Congenital Band Precipitating Pathogenic Heterotopic Mesenteric Ossification Requiring Hemicolectomy: A Case Report

“…The remaining 69 patients had previous laparotomies. This reiterates the unique nature of the presented case report because the patient developed such a strong reaction following minimally invasive surgery [ 18 ].…”

“…The pathological presentation of heterotopic mesenteric ossification has been reported as early as 3 weeks after the inciting event up until years following [ 18 ]. Imaging can be a useful adjunct in the diagnosis of heterotopic mesenteric ossificans.…”

Heterotopic Mesenteric Ossification With Trilineage Hematopoiesis

“…The exact incidence and prevalence rates for HMO are unclear because many cases are believed to be asymptomatic and underdiagnosed [ 16 ]. It is believed to be relatively rare because only fewer than 100 cases have been reported so far in the English-language literature [ 12 ]. An analysis of pooled cases from 1983 [ 8 , 10 ] to 2022 showed a median age of 49.5 years, predominantly male (92.9% or 65/70), common history of previous surgery or trauma (93.0% or 66/71), a median interval of approximately four weeks between last procedure/trauma to the diagnosis of HMO, reported marrow component (16.7% or 3/18), and most common complication of small bowel obstruction (45.3% or 29/64) [ 5 , 8 , 10 , 12 , 13 , 19 - 26 ].…”

“…However, this hypothesis does not explain the occurrence of HO in certain cases. For example, HO was identified in the inferior vena cava, where no anatomic osseous tissue was involved [ 18 ], or in cases that had no previous surgical or trauma history [ 12 ]. The low incidence rate of HO in orthopedic patients also argues against this hypothesis, considering the number of orthopedic procedures performed in clinical practice.…”

“…HO involving the mesentery, termed heterotopic mesenteric ossification (HMO) by Wilson et al [ 5 ] (also referred to as intra-abdominal myositis ossificans, mesenteritis ossificans, heterotopic ossificans of the intestinal mesentery [ 9 ]), is even rarer, with fewer than 100 cases published since the first report by Hansen et al in 1983 [ 8 , 10 - 12 ]. Of all HO cases, only nine cases reported the presence of bone marrow components, including two cases with adipose tissue [ 12 , 13 ] and seven cases of true hematopoiesis (six cases of non-mesenteric HO [ 7 , 14 - 18 ] and two cases of HMO [ 10 , 19 ]). Here, we report the third case of HMO with true trilineage hematopoiesis in a 66-year-old female following multiple abdominal surgeries.…”