Heterotopic mesenteric ossification as a cause of persistent enterocutaneous fistula: overview of the literature and addition of a new case*

Heterotopic mesenteric ossification: Report of two cases with review of the literature

“…The majority of the patients reported with HMO have presented with a prior history of abdominal operations and/or intestinal obstruction but there are other HMO reported cases presenting with enterocutaneous fistulae, peritonitis, or incidentally found on imaging or intraoperatively [11,12]. The diagnosis of HMO preoperatively has been notably difficult.…”

“…The diagnosis of HMO preoperatively has been notably difficult. However, it is of clinical significance not only due to its potential complications such as small bowel obstruction, bowel perforation and persistent enterocutaneous fistula formation, but also because of its potential to be mistaken for a malignant process [11,[13][14][15].…”

“…To differentiate from these other possibilities a repeat CT scan should be obtained when in doubt. Bone formation remains static while contrast or blood changes in position and pool in dependent areas, and dystrophic calcification typically appears as faint radiodense areas that are punctate and irregular [11,13,[15][16][17].…”

Incidental Heterotopic Mesenteric Ossifications

“…However, in our case and others in the literature, the absence of periosteum or perichondrium disruption and with formation of HMO, the seeding theory fails to explain the development of HMO. Therefore, additional theories have been developed and the prevailing theory proposes a metaplastic response that involves four factors that contribute to the development of HMO [5]. First, there must be an initial insult, such as trauma, surgical wounds or sepsis, followed by the release of signals from the site of injury by the initially injured cells or by inflammatory cells.…”

“…A small number (n = 4) of reports discussed the finding of elevated serum alkaline phosphatase in patients with HMO. Alkaline phosphatase is likely elevated as a result of osteoblastic activity and bone formation [5]. Of these, three reports noted a peak alkaline phosphatase level occurring around 3 weeks after the inciting event.…”