Heterotopic Ossification Encountered During a Complex Ventral Hernia Repair

Case Report and Literature Review

Takintope Akinbiyi, MD; Sanjeev Kaul, MD

Disclosures

ePlasty. 2017;17(e29) 

In This Article

Methods/Case Report

A 69-year-old obese man with a history of hypertension, hyperlipidemia, benign prostatic hypertrophy, coronary artery disease, and morbid obesity was diagnosed in 2010 with rectal cancer. He underwent a robot-assisted abdominoperineal resection complicated by an intraoperative injury to the right ureter requiring conversion to laparotomy. His postoperative course was complicated by abdominal compartment syndrome, requiring emergent decompressive laparotomy, and by a severe surgical site infection of his laparotomy incision. The incision eventually broke down completely, with dehiscence of the fascia resulting in an open abdomen. During an extended intensive care unit course, his abdomen was temporarily closed with a negative therapy vacuum dressing. When stable, he underwent split-thickness skin grafting directly on his viscera for coverage with continued negative pressure vacuum dressing until adequate take was achieved. After discharge and complete recovery, he developed complete loss of domain and a large ventral hernia that was symptomatic. Four years later, he presented to our clinic requesting elective repair of his ventral hernia. An otherwise unremarkable preoperative workup was notable for the computed tomographic (CT) scan demonstrating the lateralized rectus muscle with a large fascial defect and calcification within the rectus sheath, muscle, and interdigitating within the anterior small bowel (Figure 1).

Figure 1.

Sequential axial computed tomographic scans of abdominal wall showing cephalad heterotopic ossification invading into rectus muscles and interdigitating between the small bowel.

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