Heterotopic Mesenteric Ossification After a Ruptured Abdominal Aortic Aneurism: Case Report With a Review of Literatures

Abstract

Heterotopic mesenteric ossification (HMO) is a rare disease that results in intra-abdominal ossification of unknown origin. An 88-year-old man developed an intestinal obstruction 2 weeks after undergoing an operation for a ruptured abdominal aortic aneurysm, resulting in intestinal obstructions those did not improved concervatively. During relaparotomy performed 30 days after the first operation, hard adhesions of the small intestine and mesentery were found; these adhesions were difficult to separate without damaging the serosa of the small intestine. We removed 240 cm of the small intestine and performed a jejuno-ileo anastomosis. Microscopically, trabecular bone tissue had increased irregularly in the fat tissue of the nodules with fibrosis, which were partially lined with osteoblasts. Accordingly, we histopathologically diagnosed the patient as having HMO. The patient was treated with NSAIDs and cimetidine to prevent the recurrence of HMO. No signs of recurrence have occurred as of one year after the second operation.

Intra-abdominal myositis ossificans in an asymptomatic patient during closure of a Hartmann's colostomy

“…Bone lesions must be excised in cases which the ossificated areas cause bowel obstruction and abdominal symptoms. There are reports indicating that nonsteroidal anti-inflammatory drugs and cimetidine prevent the recurrence of ossification [2, 6]. In our case, the best course of action was to excise the ossificated formations found in the mesocolon and the abdominal trauma.…”

“…The development of mesentery ossification shows a preference in middle-age male population with a men to women ratio of 1.5:1 [6]. Occurrence is reported weeks to years after abdominal surgery or trauma [7].…”

“…Laboratory examinations are within normal limits, with the possibility of elevated alkaline phosphatase values found in some cases. This reflects the increased osteoblastic activity during heterotopous bone formation [6]. …”

“…Ultrasonography cannot directly depict bone formations; still it can reveal hyperechoic strands with an acoustic shadow, indicating calcification of the scanned area. Abdominal X-ray can be significant for opacificated areas with mature trabecular textures, while Tc-99m single-photon emission CT is useful for the intra-abdominal identification of bone formations [6, 9]. CT scan is the method of choice regarding diagnosis of HMO, imaging dispersed trabecular and cortical bone-like lesions in the mesentery, omentum or near the surgical incision [10].…”

Heterotopic mesenteric and omental ossification incidentally found in a patient with multiple abdominal surgical operations because of gunshot injury

“…[7,10,11] An abdominal CT scan can be helpful in the diagnosis of intra-abdominal heterotopic ossification, but the preoperative diagnosis is usually quite difficult. [8,14] On CT scan, the lesions appear as multiple branching, and linear opacities with a welldefined cortex containing internal trabecular ossifications, and this finding is nearly always depicted as contrast extravasation from the bowel lumen. [3,15] The differential diagnosis for heterotopic mesenteric ossifications includes dystrophic calcification, foreign material, calcified abdominal cysts, extraskeletal osteosarcoma, or other osseous malignancies.…”