An Unexpected Intraoperative Finding: Heterotopic Ossification of the Anterior Abdominal Wall - A Case Report

Case Report

Abstract

Abdominal heterotopic ossification is a rare entity, most commonly occurring following trauma or surgery. We report the case of a 75-year-old female patient managed for appendiceal peritoneal carcinomatosis, in whom heterotopic ossification of the anterior abdominal wall, located within the deep parietal aponeurosis, was incidentally discovered during cytoreductive surgery without HIPEC.

A total omentectomy with multiple biopsies and resection at the appendiceal base was performed. Histopathological examination revealed a moderately differentiated appendiceal adenocarcinoma with a low-grade mucinous component and vascular emboli, as well as mature osseous debris without associated tumor proliferation.

The postoperative course was uneventful, with favorable clinical recovery. The patient was referred to oncology for further management.

This case highlights the potential role of prior surgery, chronic inflammation, and the tumor microenvironment in the development of heterotopic ossification. Recognition of this entity is crucial due to the risk of misinterpretation as tumor progression and its intraoperative implications.