title: Granulomatous peritonitis after laparoscopic cholecystectomy.
abstract: BACKGROUND
  Granulomatous peritonitis may indicate a number of infectious, malignant, and idiopathic inflammatory conditions. It is a very rare postoperative complication, which is thought to reflect a delayed cellmediated response to cornstarch from surgical glove powder in  susceptible individuals. This mechanism, however, is much more likely to occur with open abdominal surgery when compared with the laparoscopic technique.
  
  
  METHODS
  We report a case of sterile granulomatous peritonitis in an 80-y-old female after a laparoscopic cholecystectomy. Management  was conservative, and no relapse was observed after over 1-y of follow-up.
  
  
  CONCLUSIONS
  We propose that peritoneal exposure to bile acids during the laparoscopic removal of the gallbladder was the trigger of granulomatous peritonitis in this patient. Severe complications, such as  peritoneal adhesions, intestinal obstruction, and fistula formation, were observed, but no fatalities were reported.
  
  
  CONCLUSIONS
  We should be aware of this rare cause of peritonitis in the surgical setting.
authors: Department of Internal Medicine, San Camillo Hospital, Circonvallazione Gianicolense, 00152 Rome, Italy. gfamularo@scamilloforlanini.rm.it
authors: Giuseppe
authors: G
authors: Famularo
authors: Daniele
authors: D
authors: Remotti
authors: Michele
authors: M
authors: Galluzzo
authors: Laura
authors: L
authors: Gasbarrone
mesh_terms: D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications