Intra-abdominal heterotopic ossification of the peritoneum following traumatic splenic rupture
A 25 year-old male was transferred to the emergency department of our hospital following a car accident (1st Surgical Department, General Regional Hospital “George Papanikolaou”, Thessaloniki, Greece, 2006). The patient, who was intubated, suffered from major trauma including an open fracture of the left tibia, an open fracture of the right radius and ulna, a right temporo-occipital subdural hematoma, fractures of the lower left ribs and splenic rupture. Splenectomy and surgical management of the fractures and the subdural hematoma were performed. The patient was then transferred to the intensive care unit (ICU). Six days later, acalculous cholecystitis was observed and open cholecystostomy was therefore conducted. On the 12th postoperative day, a tracheostomy was performed. A persistent fever and leukocytosis of unknown primary origin, at the 20th postoperative day, led to an abdominal CT scan which was normal except for the IHO of the parietal peritoneum. As the finding was incidental and was asymptomatic, the patient was managed conservatively. Fifty three days after the accident, the patient developed an esophagotracheal fistula and was therefore subjected to a gastrostomy. Because of the IHO of the parietal peritoneum, the gastrostomy was performed surgically. During the laparotomy, the IHO of the parietal peritoneum of the midline was observed and excised. Histopathological examination demonstrated mature osseous tissue (both solid and cancellous) and hyaloids cartilage and confirmed the diagnosis (). Two months after the gastrostomy, the patient, still having the gastrostomy, underwent another abdominal CT scan because of vague abdominal pain. The CT scan demonstrated recurrence of the ossification of the parietal peritoneum (). The patient was treated conservatively. Six years after the accident, the patient is alive and well while the IHO of the peritoneum is stable in size and does not cause any symptoms.