Cellulose granulomas and their relationship to intestinal obstruction.

Cellulose foreign body was initially described by the authors as a cause of granulomatous peritonitis implicating disposable surgical fabrics. The purpose of this study was to establish the incidence, origin, and clinical significance of the lesion. Of 7,500 surgical specimens and autopsies from surgical mortalities reviewed by one pathologist during a two and a half year study period, forty-five cases of cellulose foreign body granulomas were identified by light microscopy. They were examined with polarization technics and scanning electron microscopy in an attempt to determine the source of the cellulose fibers as either cotton or a wood product. The forty-five cases were identified in patients who had at least one previous surgical procedure involving the same area. Twenty-seven cases were extraperitoneal. Eighteen were located in the peritoneal cavity of which five were found at autopsy and thriteen were identified at laparotomy. Two patients had granulomatous peritonitis and six had mechanical small bowel obstruction associated with the granulomas. During the study period there were sixty operative patients of small bowel obstruction; forty-nine were due to adhesions of which thirty-seven had lysis of adhesions without biopsy. Of the twelve patients with surgical specimens, cellulose granulomas were present in six. This suggests that cellulose foreign body granuloma may be a significant cause of intestinal obstruction. The origin of the cellulose could not be definitively established in most cases because of loss of morphologic characteristics. However, fibers were positively identified as wood in two of ten cases (20 per cent) examined with scanning electron microscopy, which supports the thesis that they were derived from disposable surgical fabrics.

Diffuse small bowel involvement in malignant histiocytosis.

The extremely unusual patient reported here had malignant histiocytosis with extensive gastrointestinal involvement. The presenting symptoms were those of a gastrointestinal disorder and barium studies of the upper gastrointestinal tract revealed an infiltrative process of the entire small bowel. A biopsy of the small bowel demonstrated abnormal malignant cells and the diagnosis of malignant histiocytosis was considered and confirmed at postmortem. Strongyloidiasis, which was also found in this patient, may represent a hyperinfestation phenomenon due to altered host-parasite balance.

Granulomatous peritonitis due to cellulose fibers from disposable surgical fabrics: laboratory investigation and clinical implications.

Two patients with postoperative granulomatous peritonitis were found to have lesions with a distinctive type of foreign body. Laboratory investigation revealed this foreign body to be cellulose, morphologically identical with fibers derived from disposable surgical gowns and drapes, and cotton. The same type of foreign body granulomas was produced experimentally by introducing lint prepared from these gowns and drapes into the peritoneal cavities of rats. Since disposable gowns and drapes are being used with increasing frequency, cellulose lint derived from these sources should be added to the list of hazardous foreign materials which are potential wound contaminants.