Foreign body granulomas mimic peritoneal dissemination caused by incarcerated femoral hernia perforation: A case report

Abstract

BACKGROUND Foreign body granuloma (FBG) is a well-known type of granulomatous formation, and intraabdominal FBG (IFBG) is primarily caused by surgical residues. Multifocal IFBGs caused by gastrointestinal perforation is an extremely rare and interesting clinicopathological condition that resembles peritoneal dissemination. Here, we present a case of IFBGs mimicking peritoneal dissemination caused by bowel perforation and describe the value of intraoperative pathological examinations for rapid IFBG diagnosis. CASE SUMMARY An 86-year-old woman with an incarcerated femoral hernia was admitted to the hospital and underwent operation. During the operation, the incarcerated ileum was perforated during repair due to hemorrhage necrosis, and a small volume of enteric fluid leaked from the perforation. The incarcerated ileum was resected, and the femoral hernia was repaired without mesh. Four months later, a second operation was performed for an umbilical incisional hernia. During the second operation, multiple small, white nodules were observed throughout the abdominal cavity, resembling peritoneal dissemination. The results of peritoneal washing cytology in Douglas’ pouch and the examination of frozen nodule sections were compatible with IFBG diagnosis, and incisional hernia repair was performed. CONCLUSION IFBGs can mimic malignancy. Intraoperative pathological examinations and operation history are valuable for the rapid diagnosis to avoid excessive treatments.

A mimic of peritoneal metastatic disease, multifocal intraabdominal foreign body granulomas secondary to feculent peritonitis

“…Intraabdominal Foreign Body Granulomas (IFBGs) are intricate cellular responses to retained foreign objects commonly originating from surgical materials including sutures, gauze, sponges, talc, and starch 1–3 . Occasionally these granulomas can be caused by non‐surgical foreign bodies like fish bones, spillage of gallstone, and bowel content from perforation 4–7 .…”

“…Although the literature describes this as a rare phenomenon, surgeons anecdotally describe this process as an uncommon but notable differential of peritoneal disease 1,3 . When evaluating a patient with intraabdominal peritoneal nodules it is important to consider other differential diagnoses.…”

“…Intraabdominal Foreign Body Granulomas (IFBGs) are intricate cellular responses to retained foreign objects commonly originating from surgical materials including sutures, gauze, sponges, talc, and starch. [1][2][3] Occasionally these granulomas can be caused by non-surgical foreign bodies like fish bones, spillage of gallstone, and bowel content from perforation. [4][5][6][7] These IFBGs often present multifocally, posing a diagnostic challenge by mimicking peritoneal disease spread, particularly when associated with gastrointestinal cancer.…”

“…Although the literature describes this as a rare phenomenon, surgeons anecdotally describe this process as an uncommon but notable differential of peritoneal disease. 1,3 When evaluating a patient with intraabdominal peritoneal nodules it is important to consider other differential diagnoses. These include primary peritoneal or metastatic cancer, tuberculosis, sarcoidosis, endometriosis, mesothelioma, chronic inflammatory disease, lymphoma, fungal infections, desmoid tumours, peritoneal cysts and in this case, foreign body reactions.…”