Surgical sponges: a cause of granuloma and adhesion formation.

DEPENDING on anatomical locations, foreign body granulomas as sequellae of surgical operations are of varying clinical importance. Many substances have been recognized as etiological agents. Lycopodium and talcum powder are no longer used as glove lubricants in hospitals, and are seldom seen in surgical specimens by the pathologist. Since Lee and Lehman 5 first reported the use of non-irritating starch powder for glove lubrication, pathologists recognize its distinctive microscopic appearance under polarized light. Contamination occurs more often in the pathology cutting room, than as etiologic adhesions. Starch may produce granulomas when improperly used.1, 4, 6 Other substances such as sulfa-powder,2 condom emulsion and petrolatum 3 also have been responsible for intra-abdominal adhesions, and undoubtedly other agents will be recognized in the future. There is evidence that fragments of gauze introduced at operation may induce granulomata and deposition of fibrous tissue. For some years, one of the authors (JHS) has examined routine microscopic sections of granulomata and adhesions under polarized light, and has recognized in many specimens ragged, birefringent particles. In one case a gauze sponge was left in a knee-joint, and examination of the accompanying granuloma revealed that it contained particles identical to those previously unidentified. This led to experiments