Extensive mesenteric dystrophic calcification in a patient with chronic enterocutaneous fistula.

A 42-year-old male developed a complex entero-cutaneous fistula (ECF) after surgery for diverticulitis, followed by multiple complications, ten additional procedures and total parenteral nutrition (TPN) dependence. Despite these interventions, the complex ECF persisted, and he was transferred to our care. Imaging revealed extensive mesenteric dystrophic calcifications, though lab values were normal. Intraoperatively, dense calcifications were found infiltrating mesenteric vessels and bowel serosa without perforation. The calcifications were carefully excised, preserving blood supply. A second-look surgery confirmed bowel viability, and continuity was restored with 190 cm of small bowel. Pathology showed dystrophic calcification and bone formation without malignancy. This rare case underscores the challenges of managing chronic ECF with extensive calcification and validates a conservative approach to ischemic bowel.