Abstract
Heterotopic ossification (HO) is the ectopic development of normal bone within soft tissue that can occur after traumatic injury. It is uncommon and may be missed or misdiagnosed, which can lead to complications. We report the case of an 84-year-old male with a previous history of a laparotomy who underwent resection of an intra-abdominal tumor through a midline incision. On postoperative day six, the patient was taken to the operating room, as succus was draining from the incision. Upon re-exploration, sharp bone-like material was found in the wound directly adjacent to an enterotomy. Pathology confirmed mature lamellar bone and the diagnosis of HO. This is the first report of postoperative intestinal perforation secondary to HO in a midline wound. We report this case to encourage accurate reporting of HO and its morbidity and complications for the benefit of appropriate surgical planning and epidemiologic tracking of outcomes.
Highlights
Heterotopic ossification is the ectopic development of normal bone within soft tissue
Select case series of three, eleven, and twenty-three patients combined with isolated case reports provide the majority of our understanding of this condition [5,6,7], highlighting that heterotopic ossification can be recurrent and that it should not be misinterpreted for cancer
A thorough search of the literature revealed several reports regarding the presence and treatment of heterotopic ossification in a diversity of locations in association with a variety of traumatic injuries [4, 5, 7,8,9,10,11,12,13,14,15,16], but only one similar case of heterotopic ossification leading to intestinal perforation [17]
Summary
Heterotopic ossification is the ectopic development of normal bone within soft tissue. When found that in an abdominal scar, it may cause symptoms such as discomfort or pain, especially in active patients. When it occurs in dependent areas, it may cause tissue damage and skin breakdown. Heterotopic ossification may occur in abdominal scars. Select case series of three, eleven, and twenty-three patients combined with isolated case reports provide the majority of our understanding of this condition [5,6,7], highlighting that heterotopic ossification can be recurrent and that it should not be misinterpreted for cancer. Given the scarcity of reports, descriptions of each incidence and of the management and morbidity is paramount for improved understanding, operative planning and tracking of outcomes. We report the unique case of an 84-year-old patient who suffered postoperative intestinal perforation from heterotopic ossification in his midline abdominal wound, an occurrence that has not been previously described
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