Intraabdominal Foreign Body Granuloma Caused by Surgical Suture Mimicking Peritoneal Meatastasis—Report of a Case—

Abstract

A 72-year-old man received abdominoperineal resection, extended left hepatectomy, and partial hepatectomy of the segment 7 after mFOLFOX6 + panitumumab as neoadjuvant chemotherapy for rectal cancer with synchronous liver metastasis. We performed ileocecal resection on 7th postoperative day because of strangulated obstruction caused by a small intestine impacted into the pelvic dead space. Six months later, an abdominal CT scan showed a homogeneous mass 20 mm in diameter at the right lower quadrant of abdomen, and fluorodeoxyglucose positron emission tomography (FDG-PET) revealed intense FDG uptake at the mass. Peritoneal metastasis was suspected, and we performed surgical resection. The mass was found in the mesentery of the ileocolic anastomosis at the last operation, and we resected the intestine including the anastomosis. Pathological examination showed that silk suture material was surrounded by multinucleated giant cells with an abscess which was surrounded by cicatrized tissue and there were no malignant cells. We diagnosed it as suture granuloma. It was considered that foreign body reaction might occur by silk suture material which was used for ileocecal resection, because we sutured the mesentery by silk threads after ileocolic resection. We had difficulties to distinguish a suture granuloma from peritoneal metastasis after surgery of a malignant tumor.