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Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children
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Foreign body type reaction causing differential diagnostic difficulty after appendectomy

Tímea Seszták1, Attila Kálmán1, Áron Cseh1

  • 11 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest, Bókay János u. 53-54., 1083.

Orvosi Hetilap
|January 18, 2021
PubMed
Summary

A rare late complication of appendectomy, a suture granuloma (Schloffer tumor), presented as an abdominal mass in an 11-year-old girl. This case highlights the importance of considering foreign body reactions in diagnosing unusual post-surgical abdominal conditions.

Keywords:
Schloffer tumorSchloffer-tumorforeign body type reactiongranulomaidegen test típusú reakciópostoperative complicationposztoperatív szövődmény

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Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Pathology
  • Abdominal Imaging

Background:

  • Appendectomy complications typically manifest early post-surgery; late-onset complications are uncommon.
  • Schloffer tumor, a rare entity, is characterized by foreign body-type granulomatous inflammation, often around surgical suture material.

Observation:

  • An 11-year-old girl presented with a 2-week history of abdominal pain, 8 years after an appendectomy.
  • Initial abdominal ultrasound was normal; subsequent ultrasonography and MRI revealed an inhomogeneous, solid mass in the ileocecal region, suspected to be inflammatory.
  • Clinical presentation, laboratory tests, and imaging led to differential diagnoses including inflammatory bowel disease and malignancy.

Findings:

  • Surgical exploration revealed a tumor-like lesion on the ascending colon, which was resected.
  • Histopathological examination confirmed a foreign body suture granuloma with a central abscess, excluding malignancy.
  • The patient was also diagnosed with celiac disease.

Implications:

  • This case underscores the diagnostic challenge of late-onset foreign body granulomas (Schloffer tumors) after abdominal surgery.
  • Negative initial imaging and co-existing celiac disease complicated the diagnostic process, emphasizing the need for thorough differential diagnosis.
  • Awareness of Schloffer tumors is crucial for accurate diagnosis and management of unexplained abdominal masses in post-surgical patients.