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Heterotopic ossification (HO) is a potential complication following brain or spinal cord injuries and diseases. Post-encephalitis HO is rare, and the number of affected joints is a prognostic predictor. A literature review revealed only a limited number of such cases, with one or two anatomical regions affected in each case. We report the case of a 21-year-old man who developed HO at the peri-articular regions of both hips and the right elbow post encephalitis. He had good functional outcome following excision of the ossific masses. There has not been any recurrence for up to two years from the first surgery. To the best of our knowledge, this is the first such case involving more than two anatomical regions, and the first reported case from Sri Lanka.

Progressive heterotopic ossification (HO) is a rare disease of genetic inheritance. Fibrodysplasia ossificans progressiva (FOP) is an identified debilitating subcategory in which anomalous ossification usually begins in childhood. Congenital big toe anomalies and specific patterns of progression of ossification confirm the classic disease. Adult onset disease is extremely rare. The mechanism of disease progression is still unclear, and there is no consensus on the treatment modalities. We report a 47-year-old man with adult-onset progressive HO around the bilateral pelvic and shoulder girdles and thoracolumbar spine, which suggested a variant form of FOP. Although surgical excision is considered counterproductive in FOP, our patient showed improvement in his shoulder movement following surgery. Other management strategies, including surgery around the hips, indomethacin prophylaxis, irradiation and bisphosphonate therapy, did not improve his range of movement or disease progression.

Background and Purpose: Hepaticojejunostomy is the reconstructive procedure performed for iatrogenic bile duct injuries. Anastomotic site stricture is the most significant complication of this operation. Revision surgery is associated with a significant morbidity and mortality. Creation of access to the anastomotic site facilitates the management of such strictures by minimal access techniques and reduces the need for revision surgery. This retrospective study aims to investigate the technical accessibility, usefulness, morbidity related to and the outcome of hepaticojejunostomy with gastric access loops performed as the treatment for iatrogenic bile duct injuries., Methodology: Twenty-seven consecutive patients who have undergone hepaticojejunostomy (including three revision surgeries and a re-revision surgery) with gastric access loops from July 2005 to October 2009 were followed up for clinical, biochemical, radiological and endoscopic evidence of anastomotic site occlusion and the need for intervention. Morbidity related to gastric access loops was assessed by dyspepsia disability score., Results: Mean follow up was 35.4 (range 6-61) months. Three patients developed anastomotic strictures at 4, 22 and 5 months after hepaticojejunostomy and had successful endotherapy via the gastric access loop. They remain well at 33rd, 31st and 3rd months, respectively, following intervention. Based on the dyspepsia disability score none of the patients had symptomatic dyspepsia affecting daily activities., Conclusions: Gastric access loop is accessible and useful for stricture dilation and other endotherapeutic procedures. In the absence of significant symptoms related to bile reflux, gastric access loop could be considered as a useful and safe adjunct in the management of hepaticojejunostomy by surgeons especially in settings with limited facilities and expertise for radiological manipulations., (Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)