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

Results

His planned surgery involved removal of the prior split-thickness skin graft and a component separation of his abdominal wall, now possible due to planned extensive weight loss, to fix the ventral hernia. In addition, the calcified objects would be removed during the dissection. During the procedure, the skin graft was found to be densely adherent to the underlying small bowel. Several enterotomies were created along multiple segments of the small bowel during skin graft excision. The enterotomies were treated by resection and primary anastomosis. During the dissection, 2 areas of calcified tissue were encountered, the extent of which had not been fully appreciated on preoperative imaging. The cephalad calcified object was in the shape of a small antler just below the xiphoid. The second object was caudal and much larger in size. It had a horseshoe-like configuration that appeared to originate just above the pubic symphysis and its 2 horns spread laterally and cephalad (Figure 2 and Figure 3).

Figure 2.

Intraoperative picture showing the cephalad (a) and caudal (b) heterotopic ossified tissue within the abdominal wall.

Figure 3.

Specimens after resection. The specimen on the left was caudal, and the right specimen was cephalad in the ventral abdominal wall.

The 2 ossified objects were sharply dissected free, minimizing further injury to the small bowel. This required longitudinal incision of the left anterior rectus fascia and muscle. The cephalad and caudal structures were divided from the xiphoid and pubic symphysis, respectively, with orthopedic cutters. The remainder of the case was uneventful with bilateral component separation and local advancement flaps of the anterior rectus fascia. Final pathology documented bone with cortical reactive sclerosis consistent with HO. Postoperatively, the patient did well after an initial ileus and was discharged home without issue. At 18 months, he had no clinical evidence of recurrence.

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