Heterotopic Ossification Encountered During a Complex Ventral Hernia Repair

Case Report and Literature Review

Takintope Akinbiyi, MD; Sanjeev Kaul, MD


ePlasty. 2017;17(e29) 

In This Article


We reported a case of a 69-year-old man who developed HO after a prolonged open abdomen, eventually closed by split-thickness skin grafting. Two large collections of heterotrophic ossified tissue, invading in an almost malignant fashion, were resected during a subsequent ventral hernia repair. To our knowledge, we present the first description of HO that invaded the abdominal wall and intraperitoneal viscera in an almost malignant fashion.

Heterotopic ossification has historically been reported in the orthopedic and spinal injury literature. While not as common, it has also been reported in the trauma and burn literature as well as after midline laparotomy. Studies documenting its radiographic presence in 25% of patients following abdominal surgery suggest that its real incidence is underreported.[11] Although potential mechanisms have been proposed, the etiology is still unclear and likely multifactorial. However, inflammation has been found anecdotally and experimentally to play a major role.[24] While the location of formation is varied, the majority of cases appear to form as a sequela of upper midline incisions. The decision to offer surgical treatment is usually based on symptom burden, although our case required excision for completion of the ventral hernia repair. Currently, there is little information on the recurrence rate of HO. Some authors have advocated delaying definitive surgical treatment to decrease the risk of early recurrence; however, there is evidence that early excision is appropriate.