Granulomatous Peritonitis Secondary to Corn Starch

doi:10.1059/0003-4819-62-2-335

Granulomatous Peritonitis Secondary to Corn Starch

BARBARA BATES, M.D.

Requests for reprints should be addressed to Barbara Bates, M.D., Department of Medicine, University of Kentucky, College of Medicine,
Lexington, Ky.

Excerpt

Early in the 1950's a corn starch derivative rapidly replaced talc as the surgical glove powder of choice in this country (1). This change was brought about by the widely recognized tendency of talc to produce postoperative foreign body reactions in human tissues, manifested most often by sinus formation and most disastrously by granulomatous reactions and adhesions in the peritoneal cavity with resultant bowel obstruction (2, 3). Search began in the early 1940's for a talc substitute, and in 1947 Lee and Lehman (4) reported on the experimentally demonstrable advantages and apparent safety of a corn starch derivative later marketed

Acknowledgments

I would like to express my appreciation to Dr. Kingsley M. Stevens for the preparation and administration of the skin tests, to Dr. Daniel L. Weiss for interpretation of the pathological findings and preparation of the photomicrographs, and to them both for their interest and suggestions concerning this problem. In addition, I would like to thank Dr. Madison J. Cawein for his demonstration of in vitro phagocytosis of starch granules, Dr. Duane Tweeddale for his help with the pathological material, Dr. George M. McAdams for his observations and slide of a positive cell block preparation, and Dr. Howard Dorton for making available his patient with corn starch peritonitis. I am grateful to Dr. Frank C. Spencer for the surgical management of the patient. Finally, I would like to thank all those physicians who traced the previously reported patients so that an estimate of long-term prognosis could be made: Dr. George B. McAdams, Dr. Francis Z. Reinus, Dr. Richard N. Myers, Dr. H. M. Radke, Dr. George F. Melody, Dr. James F. Regan, Dr. Joseph R. Wilder, and Dr. Lauri Saxén.

Summario in Interlingua

Es describite un caso de peritonitis granulomatose, secundari a pulvere de guanto fabricate ex amylo de mais. Il pare que isto es le decequinte caso symptomatic reportate in le litteratura de lingua anglese, le secunde tractate con corticosteroides, e le prime con hypersensibilitate de character demonstrabile per tests cutanee. Un revista del reportate casos reflecte un syndrome que se manifesta clinicamente in evidentia de inflammation peritonee o obstruction intestinal a notar inter duo e sex septimanas post le operation. Le characteristicas pathologic include ascites, nodulos miliari, e adhesiones. Le examine microscopic revela un inflammation chronic con formation de granuloma. Particulas de amylo es facilemente demonstrabile sub lumine polarisate. Le prognose pare esser bon a longe vista. Es revistate altere typos de reportate reactiones in humanos insimul con pertinente investigationes experimental. Es sublineate le necessitate de un meticulosissime detersion de guantos chirurgic.