Walter Reed National Military Medical Center Bethesda, MD, United States
Tudor Oroian, MD Walter Reed National Military Medical Center, Bethesda, MD
Introduction: Heterotopic mesenteric ossification (HMO) is a rare, intra-abdominal, benign pseudotumor which is characterized by development of ectopic bone and cartilage within the mesentery. There are fewer than 80 documented cases of HMO. This condition predominantly affects men, with ages ranging between 21-88 with highest risks of development being due to abdominal trauma such as impact or surgery. The majority of the ossification occurs in the mesentery with fewer cases found within the omentum. Given the relatively few reported cases of this condition, there are no highly validated diagnostic criteria with the majority of cases being confirmed based on radiographic findings and histology when available.
We describe the case of an 84 year old male, presenting with early satiety and abdominal pain who was found to have heterotopic mesenteric ossification on imaging, without prior abdominal surgeries, but with a history of repeated parachute jumps during the Vietnam conflict 50 years ago. This would be the first case that would be associated with parachutism.
Case Description/Methods: An 84 year old male presented with an 18 months of progressive early satiety and epigastric pain. The patient had prior upper endoscopic evaluation approximately 10 years before for pyrosis and was found to have gastroesophageal reflux and a paraesophageal hiatal hernia.
His early satiety and abdominal pain were distinct and new from his underlying symptoms attributable to GERD and his hiatal hernia.
As part of the workup for these new symptoms, a CT of the abdomen was obtained. CT findings were consistent with heterotopic mesenteric ossification. Patient was determined not to be a surgical candidate for resection and is managing symptoms with NSAIDs.
Discussion: Heterotopic mesenteric ossification is a rare, benign condition which may be associated with variable morbidity ranging from mild abdominal pain to obstruction and perforation. This condition is usually associated with abdominal trauma, however, in some patients it can occur without these inciting factors. The relevance of this case is that even though in our patient surgery was not an option, HMO should be considered as a possible etiology for abdominal pain, obstruction, and perforation especially in patients with a history of abdominal trauma and classic radiographic findings. In cases of certain complications, surgical management may be required and could potentially be curative.
Figure: Abdominal CT of our patient with Heterotopic Mesenteric Ossification demonstrating calcification of the mesentery.
Tudor Oroian indicated no relevant financial relationships.
Tudor Oroian, MD. P1983 - History of Parachuting as Cause of Heterotopic Mesenteric Ossification in an Elderly Male, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.