A case of postoperative hepatic granuloma presumptively caused by surgical staples/clipping materials

Abstract

A 66-year-old man with postsigmoidectomy status for colon cancer received laparoscopic partial hepatectomy due to a hepatic mass with employing titanium clips were for a vascular clamp. Histological examination showed liver metastasis from sigmoid colon cancer. Twenty-nine months after the partial hepatectomy, a mass developed on the stump at the hepatic resection. Laparoscopic left lateral segmentectomy was conducted under suspicion of cancer recurrence and an automatic titanium stapling device was used. The macroscopically cut surface of the liver showed a grey-white solid nodule measuring 23 x 20 mm and involving metal clips. The nodule was consistent with granuloma microscopically. Twenty-three months after the segmentectomy, a mass reappeared on the hepatic radial margin and an open left lateral hepatic lobectomy was performed because of its growth tendency. Histopathological examination revealed granuloma similar to the previous instance. Since these nodules formed a granulomatous lesion surrounding metal staples/clips and evidence of caseous necrosis was lacking, granuloma due to surgical staples/clips was suspected. Sporadic case reports of postoperative pulmonary granuloma at the staple line have been published previously, but there are no articles detailing a case involving hepatic granuloma. We present our case as the first report of postoperative staple-line hepatic granuloma.

Biodegradable Surgical Staple Composed of Magnesium Alloy

“…As a result, artifacts owing to its high X–ray absorption coefficient can interfere with the examination of patients using computed tomography and lead to misdiagnoses in the area around the staples for the rest of their lives. Moreover, some studies have reported the adverse effects of Ti alloy staples, including allergic and foreign–body reactions and adhesion 5–8 . To overcome these disadvantages, biodegradable surgical staples are desirable.…”

Characterization of foreign materials in paraffin-embedded pathological specimens using in situ multi-elemental imaging with laser spectroscopy

“…Granulomas might develop adjacent to surgical areas or scars, and the presence of metal particles originating from components of the instruments used during the surgery or from the implants or prostheses themselves is well documented. [12][13][14][15][16][17]34,35 Therefore, particles or debris of all sizes, which are generally pigmented and birefringent or not under polarizing light microscopes, are regularly observed by on-duty pathologists. 35 Some assumptions can be made about the presence of these foreign metals.…”

“…The presence of foreign material in tissues after surgery was also investigated. This aspect has been largely documented, [12][13][14][15][16][17] and several exogenous substances, such as particles or debris, may originate from the release of components of surgical instruments, sutures, staples, implants, among other sources.…”

More on hepatic granulomas

“…We have read the case report of Nihon-Yanagi et al [ 1 ] with great interest. The patient they described developed hepatic granuloma(HG) two times and the granulomatous lesion was surrounding metal staples/clips suggesting that the granuloma was due to surgical/staples/clips.…”