Karimi Mohadeseh, Mousavi Seyed Abdollah
Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Department of Pathology, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Int J Surg Case Rep. 2024 Apr;117:109469. doi: 10.1016/j.ijscr.2024.109469. Epub 2024 Mar 7.
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.
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.
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.
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.
异位骨化是指在正常情况下不会发生骨化的组织中形成新骨。1901年，阿斯卡纳齐和卢巴什在一篇病例报告研究中首次报道了异位骨化。异位骨化的范围很广，从微小病灶到具有临床意义的大骨化。腹部瘢痕中异位骨化的发生率极低。
我们报告一名84岁男性，在当地医院进行选择性结肠造口回纳术失败后转诊至我院。大约三个月前，因乙状结肠扭转接受乙状结肠切除术后，为粪便改道进行了结肠造口术。该患者有8年高血压病史，一直在服用阿米洛利进行治疗。
总体来看，患者无病容或中毒表现。生命体征正常。术后患者未排便。体格检查未发现腹部压痛或反跳痛。患者接受了剖腹手术，术中发现严重的腹膜后粘连，并进行了结肠造口回纳术。意外地在靠近瘢痕的腹壁处发现一个质地如骨的致密结构，将其切除。标本病理检查显示有化生骨沉积，伴有成熟骨小梁，确诊为异位骨化。
我们报告了一例罕见的腹壁异位骨化病例。异位骨化可导致严重并发症。然而，对于有症状的患者，与无症状患者不同，手术切除是一种可接受的治疗方法。
