Fractured heterotopic bone in a midline abdominal wound.

PURPOSE: Heterotopic bone formation, although most often reported after trauma and elective joint surgery, can occur in abdominal surgical scars. The lesion may not be discovered for a long period of time after it occurs, and the patient, except in rare circumstances, is asymptomatic.
METHODS: A patient is reported who developed heterotopic bone formation in an upper midline incision after a Nissen fundoplication with complications. The heterotopic bone became symptomatic after it had undergone complete fracture. Symptoms disappeared after the bony mass was removed. The English-language literature was reviewed to study the clinical significance of heterotopic bone formation, particularly in abdominal wounds.
RESULTS: Literature reports of heterotopic bone formation in an abdominal wound are uncommon, and the etiology remains obscure. Symptoms are unusual and are often related to the patient's activity. This case appears to be the only report of fracture of heterotopic bone in an abdominal scar.
CONCLUSIONS: Heterotopic bone formation should be considered when a hard mass develops in an abdominal surgical scar. Excision is not indicated unless the patient develops symptoms.