術中圧縮綿から飛散した綿繊維により発生した異物性肉芽腫の1例

Intracranial Foreign Body Granuloma Caused by Fine Cotton Fibers:A case report

I．はじめに

　術後残存した手術材料の圧縮綿が原因で形成された肉芽腫はこれまでいくつか報告されている．しかしそれらの報告はすべて圧縮綿をsheetのまま術野に残してきたものばかりである．われわれは手術中に術野からの出血に対応するため圧縮綿が急に多量に必要になった．そして圧縮綿を水中で充分洗浄せずに使用し，また，圧縮綿の縁でcoagulatorを使用した．それらが原因で術野に残存したと思われる細かい綿繊維がもとになり肉芽腫が形成された稀な1例を経験したので報告する．

Reported here is a rare case of intracranial foreign body granuloma caused by fine cotton fibers originat-ing from the cotton sheet, which was used in the pre-vious Operation.

The patient was a 54-year-old woman who presented with headache and right hemiparesis. CT scan demon-strated a large enhanced tumor in the left temporal lobe. During the operation, the tumor bled easily and was hard to remove. The brain surface was covered with oxidized cellulose (Oxycell^®) after the tumor was sub-totally removed. Cotton sheets (Surgical Patty^®) were also used during the operation. The microfibrillar col-lagen hemostat (Avitene^®) was not applied. The histo-logical diagnosis was astrocytoma. Radio-chemotherapy was given. CT and MRI on the 40th day after the op-eration, showed a large tumor in the left temporal lobe, which led to suspicions of tumor recurrence. The second operation disclosed a mass which was harder in consistence than the previous one. The histological di-agnosis was foreign body granuloma, which contained a lot of fine cotton fibers. Oxcell^® was not found in it. The cotton-sheet is well documented as a cause of granuloma in the literature, but it is seldom mentioned that the foreign body granuloma is caused by cotton fi-bers, scattered in the operative fields. This case report suggests the possibility of cotton-fiber granuloma and our simple experiment indicated that a lot of cotton fi-ber might be scattered in the operative fields, if dry cotton sheets are used. These results stress that washed cotton sheets should be applied to avoid the possibility of the development of cotton-fiber foreign body granu-loma.