Laparoscopic Enterolysis of Congenital Band Precipitating Pathogenic Heterotopic Mesenteric Ossification Requiring Hemicolectomy: A Case Report

Patient: Male, 52-year-old Final Diagnosis: Heterotopic ossificans Symptoms: Abdominal pain • bloating • obstipation Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Small bowel obstruction is a relatively uncommon cause of abdominal pain in the emergency department setting. However, patients with this pathology are almost uniformly admitted to the hospital, demonstrating its clinical importance in terms of diagnostic delays and risk of clinical demise. CASE REPORT: This case report describes a patient who presented with a small bowel obstruction and no abdominal surgical or trauma history. The patient failed conservative management and proceeded to the operating room for diagnostic laparoscopy, which demonstrated a congenital band, a rare cause of bowel obstruction in the adult population. Surgical intervention was initially curative; however, the patient returned to the hospital 2 weeks later with concern for recurrent bowel obstruction. Despite computed tomography without any pathological lesion or lead point, the patient was taken back to surgery owing to high clinical concern, where an obstructing mass was found, and partial colectomy was performed. Pathological evaluation at the level of the obstruction demonstrated heterotopic mesenteric ossification, an exceedingly rare condition. This patient was managed at a community hospital general surgery program and, following 2 surgical interventions, had complete resolution of his symptoms. CONCLUSIONS: This case is unique in that it presents the surgical management of 2 uncommon conditions that occurred in a single patient. It further demonstrates the importance of clinical suspicion in the management of bowel obstruction. Further study of pathogenic congenital bands and heterotopic mesenteric ossification are required to truly understand etiology, workup, and appropriate treatment.