Epidermal cysts are congenital lesions that originate from embryonal tissue remnants. It requires histopathology for its diagnosis. In this case, we report a young male with no comorbidities presenting with perianal swelling. He was evaluated and taken up for surgery. Post operative period was uneventful and he was discharged on 2nd post operative day. He is doing well at 4 months of follow up.
Granulomas are a well recognised entity in gastrointestinal surgery. These are mainly foreign body granulomas (formed
in response to a foreign irritant, such as a suture material from a prior surgery, talc, contrast material) and immune
granulomas (in chronic inflammation). On histopathology, the foreign body giant cell reaction contains multinucleate
giant cells with nuclei that are distributed through the eosinophilic cytoplasm, in which the culprit foreign material may
often be evident. Here we present an interesting case of a distal ileal obstruction and perforation due to a foreign body
granuloma in a male with no prior history of surgery or even endoscopy where no definitive inciting foreign body could
be isolated on histopathology, leaving the cause of his foreign body reaction to remain a mystery.
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