Cellulose granulomas and their relationship to intestinal obstruction

Area of Science:

• Pathology
• Surgical Complications

Background:

• Cellulose foreign body granulomas were initially linked to disposable surgical fabrics.
• These granulomas can cause peritonitis and other adverse surgical outcomes.

Purpose of the Study:

• To determine the incidence, origin, and clinical significance of cellulose foreign body granulomas.
• To investigate the role of these granulomas in surgical pathology.

Main Methods:

• Review of 7,500 surgical specimens and autopsies by a single pathologist.
• Analysis of 45 identified cellulose foreign body granuloma cases using light microscopy, polarization, and scanning electron microscopy.
• Correlation of granuloma presence with patient surgical history and clinical outcomes, including bowel obstruction.

Main Results:

• 45 cases of cellulose foreign body granulomas were identified.
• 27 cases were extraperitoneal, and 18 were in the peritoneal cavity.
• Six cases of mechanical small bowel obstruction were associated with granulomas, suggesting a significant role in obstruction.

Conclusions:

• Cellulose foreign body granulomas are a notable cause of intestinal obstruction.
• The origin of cellulose fibers (cotton vs. wood) could not be definitively established in most cases.
• Scanning electron microscopy identified wood-derived fibers in 20% of examined cases, supporting the disposable surgical fabric hypothesis.