Postoperative Bowel Perforation due to Heterotopic Ossification (Myositis Ossificans Traumatica): A Case Report and Review of the Literature

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.

Figure 1

Intraoperative photographs demonstrating the (a) location of 3 mm × 1 cm heterotopic ossification within inferior midline wound and repaired small bowel perforation. Arrow denotes heterotopic ossification emanating from the wound. (b) Additional area of heterotopic ossification, 7 mm × 2.3 cm, in superior aspect of the wound. Arrow denotes heterotopic ossification emanating from the wound.

Figure 2

Histopathology of heterotopic ossification illustrating normal, mature lamellar bone.

Figure 3

Preoperative abdominal showing (a) no evidence of heterotopic ossification on abdominal plain film. However, there is clear (b) evidence of heterotopic ossification in the lower midline abdominal scar adjacent to bowel wall seen on abdominal CT (computerized tomography) scan. Arrow denotes heterotopic ossification.