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  • Title: The significance of starch powder contamination in the aetiology of peritoneal adhesions.
    Author: Cooke SA, Hamilton DG.
    Journal: Br J Surg; 1977 Jun; 64(6):410-2. PubMed ID: 871614.
    Abstract:
    The presence or absence of starch granulomas on the peritoneal surface or within peritoneal adhesions is reported in 20 patients subjected to a second laparotomy. Evidence is presented to show that starch granuloma formation is common in the early months following operation and that adhesions associated with starch granulomas cause intestinal obstruction. It is suggested that although starch is usually absorbed within 2 years, associated band adhesions may persist. Glove powder contamination of the peritoneal cavity may thus be a common cause of band adhesion obstruction. 20 patients were subjected to a second laparotomy, for a variety of medical indications, and the presence or absence of starch granulomas on the peritoneal surface or within peritoneal adhesions was determined. 10 of 20, the findings of which are briefly summarized in 1 sentence, case-by-case, patients had starch granulomas. In the 10 patients in whom no evidence of starch granuloma or adhesion containing starch was found, 6 had adhesions and 4 did not. In both groups overall, starch granulomas were present within adhesions in 6 of 15 patients with adhesions and within adhesions in 2 of 4 patients presenting with intestinal band obstruction. In those patients who were found to have starch granulomas within peritoneal nodules or adhesions, the time interval between the first and second operation was less than 24 months. In 7 of 10 patients this intervale was less than 12 months (5.5, average). In those cases showing no evidence of starch granulomas, only 2 of 10 underwent the second operation within 24 months of the first (range 4-115 months, average 52.5 months). The following conclusions are drawn: 1) starch contamination is usual in the peritoneal cavity; 2) starch granuloma formation is common during the early months after operation; 3) there is a cause-and-effect relationship between foreign body granulomas and adhesion formation; and 4) histological and clinical evidence suggest that the associated adhesions may persist and subsequently cause abdominal obstruction, even though starch is absorbed with time.
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