Complex Ventral Incisional Hernia Repair Requiring Resection of Severe Posterior Rectus Sheath Heterotopic Ossification: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Ventral incisional hernias are a sequela of abdominal surgery, with recurrence and complication rates influenced by patient factors and surgical technique. A less recognized but significant complicating factor is heterotopic ossification (HO), the pathological formation of bone in soft tissues. HO is often linked to prior trauma or surgery to the abdomen and is rarely reported in the posterior rectus sheath, where it may mimic calcified hematomas or tumors on imaging. When present, ossification can distort anatomical planes, complicate component separation, and necessitate resection to allow abdominal wall reconstruction and/or mesh placement. This constitutes a rare case involving extensive HO in the posterior rectus sheath excised during a ventral incisional hernia repair and abdominal wall reconstruction.

A 25-year-old otherwise healthy male was referred from an outside institution for complex abdominal wall repair one year after a motorcycle collision with extensive injuries. During initial hospitalization, he underwent exploratory laparotomy with right retroperitoneal exploration, requiring inferior vena cava (IVC) filter placement for IVC disruption from the renal hilum to the right femoral vein. He was managed with an open abdomen and Abthera VAC. Closure attempts failed due to edema despite diuresis, requiring three Abthera VAC exchanges. The abdomen was closed with midline skin closure 19 days later, though the fascia remained unrepaired. Recovery was complicated by Enterobacter cloacae wound infection treated with antimicrobials. He has persistent core weakness, requires an abdominal binder, and remains below baseline function despite improved mobility. Preoperative imaging demonstrated multiple chronic dystrophic calcifications in the abdomen and pelvis including the peritoneum.

This case demonstrates one of the most extensive examples of abdominal wall HO documented in the current literature. This highlights the surgical challenges and decision-making involved in managing heterotopic ossification during complex hernia repair, emphasizing the importance of recognizing HO preoperatively and tailoring operative planning accordingly.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2064

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