Douche-induced pelvic peritoneal starch granuloma

A case of granulomatous peritonitis occurring in a patient without previous surgical history is described. The patient was initially seen because of vaginal bleeding. Gynecologic examination disclosed an ovarian mass which, at laparotomy, grossly mimicked a carcinoma with peritoneal seeding. Histological studies revealed focal chronic granulomatous peritonitis with starch granules as determined by polarization microscopy. It is hypothesized that prolonged use by the patient of a suspension of powder in water as a douche introduced the offending agent into the pelvic peritoneum.