PMC3350174_01
Intraoperative photographs demonstrating the (a) location of 3 mm x 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 x 2.3 cm, in superior aspect of the wound. Arrow denotes heterotopic ossification emanating from the wound.
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fig1
During that search, a hard 3 mm x 1 cm irregularly shaped lesion with a sharp point was encountered along the inferior portion of the midline wound directly adjacent to the noted enterotomy (Figure 1(a)). The remainder of the midline wound was explored, and a similarly hard, larger 2.3 cm x 7 mm lesion was found at the superior portion of the wound (Figure 1(b)).
Histopathology of heterotopic ossification illustrating normal, mature lamellar bone.
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Microscopically, the two specimens were found to be normal, mature lamellar bone (Figure 2).
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.
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Rereview of the plain radiographs performed pre-operatively did not demonstrate any visible evidence of the heterotopic ossification; however, computerized tomography images performed pre-operatively demonstrated evidence of heterotopic ossification at the inferior portion of the wound in the area where the two lesions were found intraoperatively (Figure 3).