Althaqafi Raad M M, Assiri Sara Ahmad, Aloufi Rawan Abdulrahman, Althobaiti Fawaz, Althobaiti Budur, Al Adwani Mohammad
College of Medicine, Taif University, Taif, Saudi Arabia.
College of Medicine, Taif University, Taif, Saudi Arabia.
Int J Surg Case Rep. 2021 May;82:105905. doi: 10.1016/j.ijscr.2021.105905. Epub 2021 Apr 27.
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.
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.
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.
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.
异位肠系膜骨化是一种在肠系膜内的良性骨组织生长，大多继发于重复性或严重的腹部损伤，导致肠系膜内反应性骨形成。截至2020年初，文献中仅报道了73例（51篇出版物）。
一名45岁的沙特男性因复杂性阑尾炎接受了多次剖腹手术，最终行回肠造口术和结肠造口术作为黏液瘘。9个月后，该患者因开放性回肠造口术和结肠造口术还纳手术入住哈达武装部队医院普通外科，术中在小肠系膜中发现了几块质地坚硬、边缘锐利的不规则骨样组织，伴有一些类似针状的梭形结构，组织病理学检查显示为小梁骨碎片，从而确诊。
大多数病例发生在成年中晚期，男性多见，通常表现为肠梗阻或肠皮肤瘘。虽然它没有恶变潜能，但可能导致严重的肠梗阻，甚至死亡，由于其罕见，因此在众多常见的腹部疾病中难以诊断。
我们在此报告一例罕见的异位肠系膜骨化病例，应将其视为腹部手术或创伤的延迟并发症之一。在鉴别诊断时，应扩大并持续考虑重大腹部创伤或手术后异位肠系膜骨化出现的时间范围。
