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Zhang BF, Liu J, Zhang S, Chen L, Lu JZ, Zhang MQ. Heterotopic mesenteric ossification caused by trauma: A case report. World J Gastrointest Endosc 2024; 16:494-499. [PMID: 39155994 PMCID: PMC11325871 DOI: 10.4253/wjge.v16.i8.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/02/2024] [Accepted: 07/10/2024] [Indexed: 08/01/2024] Open
Abstract
BACKGROUND Heterotopic mesenteric ossification (HMO) is a clinically rare condition characterized by the formation of bone tissue in the mesentery. The worldwide reporting of such cases is limited to just over 70 instances in the medical literature. The etiology of HMO remains unclear, but the disease is possibly induced by mechanical trauma, ischemia, or intra-left lower quadrant abdominal infection, leading to the differentiation of mesenchymal stem cells into osteoblasts. Here, we present a rare case of HMO that occurred in a 34-year-old male, who presented with left lower quadrant abdominal pain. CASE SUMMARY We report the case of a 34-year-old male patient who presented with left lower abdominal pain following trauma to the left lower abdomen. He subsequently underwent surgical treatment, and the postoperative pathological diagnosis was HMO. CONCLUSION We believe that although there is limited literature and research on HMO, when patients with a history of trauma or surgery to the left lower abdomen present with corresponding imaging findings, clinicians should be vigilant in distinguishing this condition and promptly selecting appropriate diagnostic and therapeutic interventions.
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Affiliation(s)
- Bi-Fang Zhang
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Jiang Liu
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Shuai Zhang
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Ling Chen
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Jia-Zheng Lu
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Ming-Qing Zhang
- Department of Gastroenterology, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
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2
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Louis EM, Nicolaou S. Bowel obstruction and perforation secondary to progressive heterotopic mesenteric ossificans. Radiol Case Rep 2022; 17:3651-3654. [PMID: 35936874 PMCID: PMC9352512 DOI: 10.1016/j.radcr.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 12/03/2022] Open
Abstract
Heterotopic mesenteric ossification (HMO) is a rare condition which usually affects male patients. Its defining feature is hyperdense ossification in the mesentery, usually following surgery or trauma. Due to potentially serious complications that can arise from HMO, it is essential to recognize it in its nascent stages. In this case study, a 65-year-old male was imaged by CT scan serially over several years for recurrent bowel obstruction as a result of worsening HMO, providing new insight into the natural progression of this condition. Mechanical injury of the bowel eventually caused perforation and abscess formation.
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3
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Bahmad HF, Lopez O, Sutherland T, Vinas M, Ben-David K, Howard L, Poppiti R, Alghamdi S. Heterotopic mesenteric ossification: a report of two cases. J Pathol Transl Med 2022; 56:294-300. [PMID: 36128866 PMCID: PMC9510041 DOI: 10.4132/jptm.2022.07.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Heterotopic mesenteric ossification (HMO) is abnormal bone formation in tissues which usually do not undergo ossification. There are approximately 75 cases reported worldwide. We present two cases of HMO. The first case is that of a 39-year-old man who presented with abdominal pain and a computerized tomography scan of the abdomen and pelvis revealed an apple core lesion resulting in small bowel obstruction. The second case is that of a 36-year-old woman who presented 2 months after undergoing robotic gastric sleeve resection complaining of weakness and emesis. An esophagogram revealed kinking at the distal esophagus. Surgical resection was performed in both, yielding the diagnosis of HMO. There are various theories as to the pathophysiology of HMO, but no clearly defined mechanism has been established. Management should be conservative whenever possible to prevent further ossification with subsequent surgical intervention.
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Affiliation(s)
- Hisham F. Bahmad
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL,
USA
| | - Olga Lopez
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL,
USA
| | - Tyson Sutherland
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL,
USA
| | - Marisa Vinas
- Department of General Surgery, Mount Sinai Medical Center, Miami Beach, FL,
USA
| | - Kfir Ben-David
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL,
USA
- Department of General Surgery, Mount Sinai Medical Center, Miami Beach, FL,
USA
| | - Lydia Howard
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL,
USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL,
USA
| | - Robert Poppiti
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL,
USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL,
USA
| | - Sarah Alghamdi
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL,
USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL,
USA
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4
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Martinbianco EM, Lilley CM, Grech J, Mirza KM, Chen X. Heterotopic Mesenteric Ossification With Trilineage Hematopoiesis. Cureus 2022; 14:e24620. [PMID: 35664416 PMCID: PMC9150764 DOI: 10.7759/cureus.24620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/05/2022] Open
Abstract
Heterotopic ossification (HO) histologically refers to extraskeletal bone formation in non-ossifying tissues, most commonly noted in the extremities, buttocks, abdominal wall, and hip joints. HO developing in the mesentery (heterotopic mesenteric ossification, HMO) is very rare, with fewer than 100 cases reported in the literature. It usually occurs in adult male patients with a history of repeated abdominal trauma. So far, only two cases of HMO have been reported with the development of hematopoietic bone marrow. Here, we report the third case of HMO with true trilineage hematopoiesis in a 66-year-old female with suspicious mesenteric-retained foreign material from prior surgical procedures, including hysterectomy for endometrial adenocarcinoma and multiple repairs for incisional hernia.
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Ramot Y, Rousselle S, Steiner M, Lavie Y, Ezov N, Nyska A. Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs. Toxicol Pathol 2021; 50:211-217. [DOI: 10.1177/01926233211067960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.
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Affiliation(s)
- Yuval Ramot
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
| | | | | | | | - Nati Ezov
- Envigo CRS (Israel), Ness Ziona, Israel
| | - Abraham Nyska
- Toxicologic Pathology, Tel Aviv and Tel Aviv University, Tel Aviv, Israel
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6
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Althaqafi RMM, Assiri SA, Aloufi RA, Althobaiti F, Althobaiti B, Al Adwani M. A case report and literature review of heterotopic mesenteric ossification. Int J Surg Case Rep 2021; 82:105905. [PMID: 33962265 PMCID: PMC8113807 DOI: 10.1016/j.ijscr.2021.105905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction and importance Heterotopic mesenteric ossification is a benign bony tissue growth in the mesentery that mostly follows repetitive or severe abdominal injuries leading to reactive bone formation in the mesentery. There are only 73 cases (51 publications) identified in the literature up to the beginning of 2020. Case presentation 45-year-old Saudi male underwent multiple laparotomies to manage complicated appendicitis which ended with a diverting ileostomy and a colostomy as a mucus fistula. After 9 months, the patient was admitted to the General Surgery department in Al-Hada Armed Forces Hospital for an open ileostomy and colostomy reversal surgery where several irregular bone-like tissues of hard consistency and sharp edges with some spindle-shaped structures resembling needles were found in the mesentery of the small intestine and histopathology revealed of trabecular bone fragments confirming the diagnosis. Clinical discussion The majority of cases occur mid to late adulthood with a predilection in the male gender, and usually present with bowel obstruction or an enterocutaneous fistula. Although it has no malignant potential, it may cause severe bowel obstruction that can lead to mortality, it's a rare occurrence and, therefore, is difficult to diagnose among many common abdominal disturbances. Conclusion Here we report a rare case of heterotopic mesenteric ossification, which should be considered as one of the delayed complications of abdominal surgery or trauma. The time range of expecting the presentation of heterotopic mesenteric ossification following major abdominal trauma or surgery should be extended and continuously considered during differential diagnosis. One of the delayed complications of abdominal surgery or trauma is Heterotopic mesenteric ossification. Since 1983 there are only 73 cases of Heterotopic mesenteric ossification published to date. Preoperative diagnosis of Heterotopic mesenteric ossification should be based mainly on the characteristic radiographic findings without relying on the levels of calcium or alkaline phosphatase. The only way to reach the definitive diagnosis is through excision and histopathological analysis. Heterotopic mesenteric ossification has no malignant potential, but it can cause severe bowel obstruction that can lead to mortality in already sick patients.
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Affiliation(s)
| | | | | | - Fawaz Althobaiti
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Budur Althobaiti
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mohammad Al Adwani
- Department of General Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
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7
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Andrea Aurelio R, Nicola DR, Stefani C, Francesco S, Alberto F, Anna Vittoria M, Roberta G. An unusual case of bowel obstruction in emergency surgery: The heterotopic mesenteric ossification. SAGE Open Med Case Rep 2020; 8:2050313X20926042. [PMID: 32637108 PMCID: PMC7323276 DOI: 10.1177/2050313x20926042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/16/2020] [Indexed: 12/05/2022] Open
Abstract
The heterotopic mesenteric ossification, also known as myositis ossificans, is a rare form of heterotopic ossification, a metaplastic phenomenon where new bone is formed in the mesenteric base, generally after abdominal trauma (surgical or other). The pathophysiology of heterotopic mesenteric ossification is unknown; clinical presentation is not specific, with vague abdominal symptoms, uncertain radiological findings, and often regular laboratory exams. No consensus exists on the best possible approach, although it might well be both medical and surgical. We reviewed the clinical history of a 28-year-old man with a recent motor vehicle accident who was admitted to our surgical unit with symptoms consistent with a small bowel obstruction; after surgery, a diagnosis of myositis ossificans was surprisingly made.
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Affiliation(s)
| | - De Ruvo Nicola
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Caramaschi Stefani
- Department of Maternal, Child and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Serra Francesco
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Farinetti Alberto
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Mattioli Anna Vittoria
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
| | - Gelmini Roberta
- Department of Surgery, University of Modena and Reggio Emilia - Policlinico of Modena, Modena, Italy
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8
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Extensive Circumferential Heterotopic Ossification Discovered at the Base of a Loop Ileostomy. Case Rep Surg 2019; 2019:4036716. [PMID: 31886007 PMCID: PMC6914893 DOI: 10.1155/2019/4036716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/17/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
Heterotopic ossification is a rare phenomenon defined by the formation of bone within nonossifying soft tissues. A rare variant of heterotopic ossification is heterotopic mesenteric ossification (HMO), in which there is involvement of the mesentery and surrounding intra-abdominal structures. There are only four previously reported cases of HMO involving an ileostomy. We present a case of HMO affecting an ileostomy which was discovered during elective stoma reversal in a 52-year-old male who required fecal diversion following perineal necrotizing fasciitis.
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9
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Amalfitano M, Fyfe B, Thomas SV, Egan KP, Xu M, Smith AG, Kaplan FS, Shore EM, Pignolo RJ. A case report of mesenteric heterotopic ossification: Histopathologic and genetic findings. Bone 2018; 109:56-60. [PMID: 29320714 DOI: 10.1016/j.bone.2018.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/06/2018] [Indexed: 02/08/2023]
Abstract
Mesenteric heterotopic ossification (MHO) is very rare and occurs in mid- to late-adulthood, usually in the context of prior abdominal surgery. The mechanisms of MHO are unknown. Here we describe the case of a 72-year-old man with MHO. Standard histological staining revealed that MHO occurred through an endochondral process. By comparison to known mutations in genetic conditions of HO such as fibrodysplasia ossificans progressiva (FOP) and progressive osseous heteroplasia (POH), DNA sequencing analysis demonstrated the presence of a commonly occurring heterozygous synonymous polymorphism (c.690G>A; E230E) in the causative gene for FOP (ACVR1/ALK2). However, no frameshift, missense, or nonsense mutations in ACVR1, or in the causative gene for POH (GNAS), were found. Although genetic predisposition may play a role in MHO, our data suggest that mutations which occur in known hereditary conditions of HO are not the primary cause.
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Affiliation(s)
- Matthew Amalfitano
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Billie Fyfe
- Department of Pathology and Laboratory Medicine, Rutgers - Robert Wood Johnson Medical School, Department of Pathology and Laboratory Medicine, United States
| | - Sumi V Thomas
- Department of Pathology and Laboratory Medicine, Rutgers - Robert Wood Johnson Medical School, Department of Pathology and Laboratory Medicine, United States
| | - Kevin P Egan
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Meiqi Xu
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Andrew G Smith
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Frederick S Kaplan
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Eileen M Shore
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Center for Research in FOP and Related Disorders, University of Pennsylvania School of Medicine, Philadelphia, PA, United States; Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Robert J Pignolo
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, United States.
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10
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Ferreira C, Gomes C, Melo A, Tenreiro N, Pinto B, Moreira H, Ribeiro A, Avelar P. Heterotopic mesenteric and abdominal wall ossification - Two case reports in one institution. Int J Surg Case Rep 2017. [PMID: 28623757 PMCID: PMC5475359 DOI: 10.1016/j.ijscr.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Heterotopic ossification (HO) is related with the abnormal bone formation in tissues that normally do not ossify. Heterotopic mesenteric ossification is a rare form of HO, characterized by the formation of an ossificant pseudotumor in the mesenteric base. Pathophysiology of HO has been postulated to be due to osteoblastic metaplasia of multipotent mesenchymal cells in response to stimulus. Prognosis of HO is generally good, so treatment should be conservative, avoiding surgery to prevent further ossification.
Introduction Heterotopic ossification occurs when bone develops in tissues which usually don’t undergo ossification. Heterotopic mesenteric ossification, also known as intra-abdominal myositis ossificans, is a rare and benign form of ossification, usually related with previous abdominal surgery or trauma. Presentation of cases We report two cases of heterotopic ossification both after multiple abdominal surgeries, with intraoperative findings of mesenteric and abdominal wall ossification. Histopathology revealed metaplastic bone deposition, without evidence of atypia or malignancy. Discussion This rare entity shares clinical and pathological characteristics of myositis ossificans. It is important to consider the differential diagnosis with sarcomas. In the cases described, the patients were proposed for elective surgery and this pathology was as an incidental finding. Conclusion The simultaneous presence of mesenteric and abdominal wall ossification in both patients makes these cases even rarer.
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Affiliation(s)
- Cátia Ferreira
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal.
| | - Carina Gomes
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Ana Melo
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Nádia Tenreiro
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Bruno Pinto
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Herculano Moreira
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Artur Ribeiro
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
| | - Paulo Avelar
- Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508 Vila Real, Portugal
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11
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Sun L, Marey G, Barrera K, Roudnitsky V, Talus H. Heterotopic Mesentery Ossification after Abdominal Surgery. Am Surg 2016. [DOI: 10.1177/000313481608201208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lucy Sun
- Department of Surgery Kings County Hospital Center Brooklyn, New York
| | - Gamal Marey
- Department of Surgery Kings County Hospital Center Brooklyn, New York
| | - Kaylene Barrera
- Department of Surgery Kings County Hospital Center Brooklyn, New York
| | - Valery Roudnitsky
- Department of Surgery Kings County Hospital Center Brooklyn, New York
| | - Henry Talus
- Department of Surgery Kings County Hospital Center Brooklyn, New York
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12
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Amin A, Safaya A, Ronny F, Islam H, Bhuta K, Rajdeo H. Hemorrhagic Shock from Spontaneous Splenic Rupture Requiring Open Splenectomy in a Patient Taking Rivaroxaban. Am Surg 2016. [DOI: 10.1177/000313481608200208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Arpit Amin
- Department of Surgery Westchester Medical Center–New York Medical College Valhalla, New York
| | - Aditya Safaya
- Department of Surgery Westchester Medical Center–New York Medical College Valhalla, New York
| | - Faisal Ronny
- Department of Pathology Westchester Medical Center–New York Medical College Valhalla, New York
| | - Humayun Islam
- Department of Pathology Westchester Medical Center–New York Medical College Valhalla, New York
| | - Kalyani Bhuta
- Department of Surgery Westchester Medical Center–New York Medical College Valhalla, New York
| | - Heena Rajdeo
- Department of Surgery Westchester Medical Center–New York Medical College Valhalla, New York
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