GLOVE POWDER GRANULOMA IN PERITONEAL CAVITY

Six weeks after a laparotomy for duodenal ulcers a patient returned to the hospital with findings strongly suggesting acute appendicitis. When the peritoneal cavity was reopened, approximately a liter of fluid was found, and the terminal ileum, cecum, and ascending colon were studded with innumerable vesicular lesions, 2 to 3 mm. in diameter, each containing a minute white center. The condition had an appearance of a granulomatous enteritis not amenable to surgery, and correction was not attempted. Persistent symptoms and radiologic abnormalities necessitated reoperation two weeks later, when resection of the terminal ileum, cecum, and ascending colon, with ileocolostomy, was carried out. Microscopic examination of the tissues indicated that the small lesions were starch granulomas. It appeared likely that a minute quantity of glove powder from the first operation had sufficed to cause this severe reaction leading to serious diagnostic problems and a long period of disability.