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A 58-year-man presented with a 9-month history of a painful swelling in a left paramedian scar. In 1966, he had a Polya gastrectomy, for peptic ulcer disease. In 1993, he presented with severe biliary reflux oesophagitis. Upper endoscopy confirmed the diagnosis. He was treated with omeprazole and cisapride with little improvement. He was referred for surgical opinion and in 1996, he had a 'Roux en y' reconstruction. This was followed 8 weeks later by laparotomy for division of omental adhesions causing jejunal obstruction. On this third laparotomy, ectopic calcifications were noted in the scar. Postoperatively, he developed a wound infection followed by a small bowel fistula, which closed spontaneously.
In 1997, he presented with a tender mass under the laparotomy scar. Initially, ultrasound and magnetic resonance imaging (MRI) confirmed a soft tissue mass. The pain in the scar increased gradually over the next few months, and surgical exploration of the mass was indicated. A pre-operative plain X-ray showed abdominal wall calcifications.
At operation, a 140 x 45 mm piece of mature bone was found underneath the scar, between the posterior rectus sheath and the peritoneum. This was dissected and was found to merge with the xiphoid cartilage. The bone was divided just below the lower end of the sternum using a bone-cutting forceps.
Histology