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Karimi M, Mousavi SA. "Heterotopic abdominal wall ossification: A case report" information. Int J Surg Case Rep 2024; 117:109469. [PMID: 38460290 PMCID: PMC10943427 DOI: 10.1016/j.ijscr.2024.109469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Heterotopic ossification is forming a new bone in tissues that do not normally ossify. HO was first reported in 1901 by Askanazy and Lubarsh in a case report study. The range of HO is wide from minute foci to large clinically significant ossification. The incidence of HO in abdominal scars is extremely low. CASE PRESENTATION We present an 84-year-old man referred to our hospital after an unsuccessful elective colostomy reversal in a local hospital. The colostomy was made for fecal diversion after sigmoidectomy due to treatment of sigmoid volvulus about three months ago. The patient had a past medical history of hypertension for 8 years under treatment of amiloride. CLINICAL DISCUSSION In general appearance, the patient was not ill or toxic. Vital signs were normal. Postoperatively Patient did not defecate. In his physical examination was not found abdominal tenderness or rebound tenderness. The patient underwent laparotomy which revealed significant retroperitoneal adhesion and colostomy was reversed. Accidentally was found a dense structure with bone-like consistency in the abdominal wall close to the scar was resected. The specimen Pathologic examination showed metaplastic bone deposition with mature bone trabeculae and heterotopic ossification was confirmed. CONCLUSION We report a rare case of HO that was identified at the abdominal wall. Heterotopic ossification can lead to serious complications. However, in symptomatic patients, surgical excision is an acceptable treatment, unlike in asymptomatic patients.
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Affiliation(s)
- Mohadeseh Karimi
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Seyed Abdollah Mousavi
- Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Bohner M, Maazouz Y, Ginebra MP, Habibovic P, Schoenecker JG, Seeherman H, van den Beucken JJ, Witte F. Sustained local ionic homeostatic imbalance caused by calcification modulates inflammation to trigger heterotopic ossification. Acta Biomater 2022; 145:1-24. [PMID: 35398267 DOI: 10.1016/j.actbio.2022.03.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022]
Abstract
Heterotopic ossification (HO) is a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues. Despite being a frequent complication of orthopedic and trauma surgery, brain and spinal injury, the etiology of HO is poorly understood. The aim of this study is to evaluate the hypothesis that a sustained local ionic homeostatic imbalance (SLIHI) created by mineral formation during tissue calcification modulates inflammation to trigger HO. This evaluation also considers the role SLIHI could play for the design of cell-free, drug-free osteoinductive bone graft substitutes. The evaluation contains five main sections. The first section defines relevant concepts in the context of HO and provides a summary of proposed causes of HO. The second section starts with a detailed analysis of the occurrence and involvement of calcification in HO. It is followed by an explanation of the causes of calcification and its consequences. This allows to speculate on the potential chemical modulators of inflammation and triggers of HO. The end of this second section is devoted to in vitro mineralization tests used to predict the ectopic potential of materials. The third section reviews the biological cascade of events occurring during pathological and material-induced HO, and attempts to propose a quantitative timeline of HO formation. The fourth section looks at potential ways to control HO formation, either acting on SLIHI or on inflammation. Chemical, physical, and drug-based approaches are considered. Finally, the evaluation finishes with a critical assessment of the definition of osteoinduction. STATEMENT OF SIGNIFICANCE: The ability to regenerate bone in a spatially controlled and reproducible manner is an essential prerequisite for the treatment of large bone defects. As such, understanding the mechanism leading to heterotopic ossification (HO), a condition triggered by an injury leading to the formation of mature lamellar bone in extraskeletal soft tissues, would be very useful. Unfortunately, the mechanism(s) behind HO is(are) poorly understood. The present study reviews the literature on HO and based on it, proposes that HO can be caused by a combination of inflammation and calcification. This mechanism helps to better understand current strategies to prevent and treat HO. It also shows new opportunities to improve the treatment of bone defects in orthopedic and dental procedures.
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Althaqafi RMM, Assiri SA, Aloufi RA, Althobaiti F, Althobaiti B, Al Adwani M. A case report and literature review of heterotopic mesenteric ossification. Int J Surg Case Rep 2021; 82:105905. [PMID: 33962265 PMCID: PMC8113807 DOI: 10.1016/j.ijscr.2021.105905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
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. One of the delayed complications of abdominal surgery or trauma is Heterotopic mesenteric ossification. Since 1983 there are only 73 cases of Heterotopic mesenteric ossification published to date. Preoperative diagnosis of Heterotopic mesenteric ossification should be based mainly on the characteristic radiographic findings without relying on the levels of calcium or alkaline phosphatase. The only way to reach the definitive diagnosis is through excision and histopathological analysis. Heterotopic mesenteric ossification has no malignant potential, but it can cause severe bowel obstruction that can lead to mortality in already sick patients.
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Affiliation(s)
| | | | | | - Fawaz Althobaiti
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Budur Althobaiti
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mohammad Al Adwani
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
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Choi H, Choi JW, Ryu DH, Woo CG, Kim KB. Spontaneous heterotopic mesenteric ossification around the pancreas causing duodenal stenosis: A case report with literature review. Int J Surg Case Rep 2021; 81:105702. [PMID: 33820732 PMCID: PMC8073193 DOI: 10.1016/j.ijscr.2021.105702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 10/31/2022] Open
Abstract
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.
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Affiliation(s)
- Hanlim Choi
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
| | - Jae-Woon Choi
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
| | - Chang Gok Woo
- Department of Pathology, Chungbuk National University Hospital, Cheongju, Republic of Korea.
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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Extensive Circumferential Heterotopic Ossification Discovered at the Base of a Loop Ileostomy. Case Rep Surg 2019; 2019:4036716. [PMID: 31886007 PMCID: PMC6914893 DOI: 10.1155/2019/4036716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/17/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
Heterotopic ossification is a rare phenomenon defined by the formation of bone within nonossifying soft tissues. A rare variant of heterotopic ossification is heterotopic mesenteric ossification (HMO), in which there is involvement of the mesentery and surrounding intra-abdominal structures. There are only four previously reported cases of HMO involving an ileostomy. We present a case of HMO affecting an ileostomy which was discovered during elective stoma reversal in a 52-year-old male who required fecal diversion following perineal necrotizing fasciitis.
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Amalfitano M, Fyfe B, Thomas SV, Egan KP, Xu M, Smith AG, Kaplan FS, Shore EM, Pignolo RJ. A case report of mesenteric heterotopic ossification: Histopathologic and genetic findings. Bone 2018; 109:56-60. [PMID: 29320714 DOI: 10.1016/j.bone.2018.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/06/2018] [Indexed: 02/08/2023]
Abstract
Mesenteric heterotopic ossification (MHO) is very rare and occurs in mid- to late-adulthood, usually in the context of prior abdominal surgery. The mechanisms of MHO are unknown. Here we describe the case of a 72-year-old man with MHO. Standard histological staining revealed that MHO occurred through an endochondral process. By comparison to known mutations in genetic conditions of HO such as fibrodysplasia ossificans progressiva (FOP) and progressive osseous heteroplasia (POH), DNA sequencing analysis demonstrated the presence of a commonly occurring heterozygous synonymous polymorphism (c.690G>A; E230E) in the causative gene for FOP (ACVR1/ALK2). However, no frameshift, missense, or nonsense mutations in ACVR1, or in the causative gene for POH (GNAS), were found. Although genetic predisposition may play a role in MHO, our data suggest that mutations which occur in known hereditary conditions of HO are not the primary cause.
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Affiliation(s)
- Matthew Amalfitano
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Billie Fyfe
- Department of Pathology and Laboratory Medicine, Rutgers - Robert Wood Johnson Medical School, Department of Pathology and Laboratory Medicine, United States
| | - Sumi V Thomas
- Department of Pathology and Laboratory Medicine, Rutgers - Robert Wood Johnson Medical School, Department of Pathology and Laboratory Medicine, United States
| | - Kevin P Egan
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Meiqi Xu
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Andrew G Smith
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Frederick S Kaplan
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Eileen M Shore
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Robert J Pignolo
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, United States.
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Wójcik G, Piskorz J, Bulikowski W. Massive peritoneal cavity calcification in the course of advanced ovarian cancer: a case report. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2015; 14:149-51. [PMID: 26327904 PMCID: PMC4498033 DOI: 10.5114/pm.2015.52156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/28/2014] [Accepted: 04/13/2015] [Indexed: 11/17/2022]
Abstract
Ovarian cancer usually does not give any clinical signs until it reaches a large size. This condition is often associated with the occurrence of metastases within the peritoneal cavity, pelvic and abdominal cavities. Ovarian cancer can spread by intraperitoneal implantation, by way of the lymphatic system, and also through the systemic circulation. Even when the tumor reaches a large size, the symptoms are not specific and may resemble other ailments. Therefore, ovarian cancer is detected in most cases only in the third and fourth level of advancement. Peritoneal calcification occurs in many diseases. The degree of calcium deposits is usually small and does not give clinical symptoms. In the reported case, computed tomography of the abdomen showed numerous scattered peritoneal calcifications of irregular shape as well as massive calcification in the uterus and appendages. In the detection of changes associated with calcification, multidetectory computed tomography shows a very high sensitivity. It makes the precise location and assessment of the extent of changes possible.
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Affiliation(s)
- Gustaw Wójcik
- Department of Diagnostic Imaging, Zofia Zamoyski Tarnowska Provincial Hospital in Tarnobrzeg, Tarnobrzeg, Poland
- Department of Rehabilitation, Physiotherapy and Balneotherapy, Medical University of Lublin, Lublin, Poland
| | - Jolanta Piskorz
- Department of Anesthesiology and Intensive Care, Zofia Zamoyski Tarnowska Provincial Hospital in Tarnobrzeg, Tarnobrzeg, Poland
| | - Włodzimierz Bulikowski
- Department of Rehabilitation, Physiotherapy and Balneotherapy, Medical University of Lublin, Lublin, Poland
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Schiergens TS, Reichelt A, Thasler WE, Rentsch M. Abdominal bone formation. J Gastrointest Surg 2015; 19:579-80. [PMID: 25572973 DOI: 10.1007/s11605-014-2737-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/16/2014] [Indexed: 01/31/2023]
Abstract
A 34-year-old man with a history of severe peritonitis was referred to the hospital for reconstruction of intestinal continuity. Preoperative CT scan revealed extensive heterotopic mesenteric ossification (HMO). Intestinal continuity was then reconstructed after complete removal of the enormous dendritic intraabdominal bone formation. The exact etiology of HMO remains unknown. It is hypothesized to result from the dislocation of small osseous fragments from the xiphoid or os pubis as well as from osteogenic differentiation of local mesenchymal progenitor cells.
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Affiliation(s)
- Tobias S Schiergens
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany,
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