Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2021; 12(11): 1083-1088
Published online Nov 24, 2021. doi: 10.5306/wjco.v12.i11.1083
Foreign body granulomas mimic peritoneal dissemination caused by incarcerated femoral hernia perforation: A case report
Shinpei Ogino, Tatsuya Matsumoto, Yosuke Kamada, Noriaki Koizumi, Hiroshi Fujiki, Kenji Nakamura, Takeshi Yamano, Chouhei Sakakura
Shinpei Ogino, Tatsuya Matsumoto, Yosuke Kamada, Noriaki Koizumi, Hiroshi Fujiki, Kenji Nakamura, Chouhei Sakakura, Department of Surgery, Akashi City Hospital, Akashi 673-8501, Hyogo, Japan
Takeshi Yamano, Department of Pathology, Akashi City Hospital, Akashi 673-8501, Hyogo, Japan
Author contributions: Ogino S was a major contributor; Matsumoto T, Yamano T and Sakakura C supervised in writing the manuscript; Ogino S, Kamada Y, Koizumi N, Fujiki H and Nakamura K performed patient treatment; Yamano T performed the pathological diagnosis; all authors read and approved the final manuscript.
Informed consent statement: The study participant provided informed written consent prior to their treatments and study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this study or its publication.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Shinpei Ogino, MD, PhD, Doctor, Surgeon, Department of Surgery, Akashi City Hospital, 1-33 Takasho-machi, Akashi 673-8501, Hyogo, Japan.
Received: May 22, 2021
Peer-review started: May 22, 2021
First decision: August 18, 2021
Revised: August 20, 2021
Accepted: September 30, 2021
Article in press: September 30, 2021
Published online: November 24, 2021

Foreign body granuloma (FBG) is a well-known type of granulomatous formation, and intraabdominal FBG (IFBG) is primarily caused by surgical residues. Multifocal IFBGs caused by gastrointestinal perforation is an extremely rare and interesting clinicopathological condition that resembles peritoneal dissemination. Here, we present a case of IFBGs mimicking peritoneal dissemination caused by bowel perforation and describe the value of intraoperative pathological examinations for rapid IFBG diagnosis.


An 86-year-old woman with an incarcerated femoral hernia was admitted to the hospital and underwent operation. During the operation, the incarcerated ileum was perforated during repair due to hemorrhage necrosis, and a small volume of enteric fluid leaked from the perforation. The incarcerated ileum was resected, and the femoral hernia was repaired without mesh. Four months later, a second operation was performed for an umbilical incisional hernia. During the second operation, multiple small, white nodules were observed throughout the abdominal cavity, resembling peritoneal dissemination. The results of peritoneal washing cytology in Douglas’ pouch and the examination of frozen nodule sections were compatible with IFBG diagnosis, and incisional hernia repair was performed.


IFBGs can mimic malignancy. Intraoperative pathological examinations and operation history are valuable for the rapid diagnosis to avoid excessive treatments.

Keywords: Foreign body granuloma, Peritoneal dissemination, Peritoneal seeding, Perforation, Operation, Case report

Core Tip: Multifocal intraabdominal foreign body granulomas (IFBGs) caused by gastrointestinal perforation are clinically rare and mimic peritoneal dissemination. An 86-year-old woman underwent an operation to treat an incarcerated femoral hernia; however, the incarcerated ileum was perforated due to hemorrhage necrosis, resulting in incarcerated ileum resection. After 4 mo, a second laparoscopic operation was conducted for an umbilical incisional hernia; however, small, white nodules were identified throughout the entire abdominal cavity, mimicking peritoneal dissemination. Using intraoperative cytology and frozen sections, the nodules were diagnosed as IFBGs. IFBGs sometimes mimic peritoneal dissemination, and intraoperative pathological examinations are effective for rapid diagnosis.