Suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery: a case report

Abstract

Background Suture granuloma with hydronephrosis after abdominal surgery is extremely rare. We herein report a successfully treated case of suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery. Case presentation A 63-year-old male underwent laparoscopic low anterior resection with covering ileostomy. Two months after primary operation, ileostomy closure was performed with two layered hand-sewn suture (Albert–Lembert method) using absorbable suture. In that operation, marginal blood vessels in the mesentery were ligated with silk suture. The patient had remained in remission with no evidence of tumor recurrence, however, 2 years and 5 months after primary surgery, a contrast-enhanced computed tomography (CT) scan showed a mass-forming lesion on the right external iliac artery (43 × 26 mm) and hydronephrosis. Positron emission tomography/computed tomography (PET/CT) showed a mass-forming lesion without high accumulation, which obstructed the right ureter. Recurrence could not be ruled out due to the rapid appearance of tumor and hydronephrosis in the short-term period. Thus, the patient underwent laparotomy. The tumor located in the mesentery near the anastomosis of ileostomy closure and it was strongly adherent to the retroperitoneum, which obstructed the right ureter. The adhesion between the tumor and ureter was carefully dissected and tumor resection with partial small bowel resection was then performed with preservation of the ureter using ureteral stents. Pathological examination of the tumor revealed fibrous proliferation of foreign body granuloma. In the resected tumor, sutures with foreign giant cells were found. Therefore, we diagnosed the tumor as silk suture granuloma, which was caused by the silk suture used to ligate blood vessels of the mesentery at the ileostomy closure. The patient remained well with no evidence of tumor recurrence as 5 years after the primary operation of rectal cancer. Conclusions Suture granuloma is a rare surgery-related complication in the postoperative surveillance of patients with colorectal cancer. If suture granuloma mimicking local recurrence is a differential diagnosis, it would be important to consider to avoid unnecessary extended resection.

Polymer clip granuloma mimicking lymph node recurrence: a case report

“…This in turn recruits fibroblasts to encapsulate the foreign body in the collagen matrix [ 11 ]. Our review of case reports on PubMed using keywords “foreign body granuloma” and “colon cancer or colorectal cancer” revealed that silk sutures were primarily responsible for most cases of foreign body granuloma following colorectal cancer surgery [ 1 – 5 , 7 , 12 – 14 ]. Table 1 shows the recent English case reports of foreign body granuloma after colorectal cancer surgery with the present case indicated as No.…”

An Intrahepatic Fluorodeoxyglucose (FDG)-PET/CT False-Positive Tumor Secondary to Foreign Body Granuloma Masquerading as Colon Cancer Liver Metastasis: A Case Report

“…Foreign body granulomas develop because of an inflammatory reaction against a foreign body left in the body after surgery, commonly referred to as Schloffer’s tumor [ 2 , 3 ]. Silk threads are a commonly used surgical material with non-absorbable properties to the organism.…”

“…Foreign body granulomas are postoperative granulomas that may develop because of surgical materials [ 1 , 2 ]. Schloffer reported a mass in a patient’s wound after performing an inguinal hernia surgery in 1909, which developed due to the ligature suture [ 3 ].…”