Foreign body type reaction causing differential diagnostic difficulty after appendectomy

Osszefoglalo. Az appendectomia szovődmenyei a leggyakrabban a korai posztoperativ időszakban jelentkeznek. A műtet utan evekkel megjelenő szovődmeny ritka. Egy 11 eves kislanyt vizsgaltunk 2 hete fennallo hasi panaszok miatt. Anamneziseben 8 evvel ezelőtt hagyomanyos modon elvegzett appendectomia szerepel. Az Ausztriaban keszult első hasi ultrahangvizsgalat elterest nem talalt. Az intezetunkben elvegzett kepalkoto vizsgalatok - hasi ultrahang, MR-vizsgalat - ileocoecalisan elhelyezkedő szolid terimet igazoltak, es felvetettek a folyamat gyulladasos eredetet. A szerteagazo klinikai tunetek, a laboratoriumi es a kepalkoto diagnosztikai elteresek kapcsan differencialdiagnosztikai szempontbol a gyulladasos belbetegseg lehetősege is felmerult, es biztonsaggal a tumoros folyamatot sem sikerult kizarni. A rosszabbodo status miatt műtet tortent. Ennek soran a colon ascendenssel osszefuggő, makroszkoposan tumoros megjelenesű elvaltozast tavolitottak el. A szovettani vizsgalat malignitast nem igazolt, a folyamat idegen test okozta - varroanyag-granuloma - kronikus gyulladasos jelleget erősitette meg. A vizsgalatok kapcsan coeliakia is igazolodott. A hasi műtetek ritka szovődmenye a Schloffer-tumor, melyet idegen test tipusu - gyakran sebeszi varroanyag-maradvany koruli - granulomatosus gyulladasos folyamat jellemez. Az entitas ismerete differencialdiagnosztikai szempontbol fontos. Nehezitette a diagnozist az első hasi ultrahangvizsgalat negativ eredmenye es az egyidejűleg manifesztalodo coeliakia. Orv Hetil. 2021; 162(3): 112-115. Summary. Generally, complications with appendectomy occur during the early postoperative stage and are quite rare years after the operation. In case of late manifestation of complications, the clinical signs are generally unspecific. We report a case of an 11-year-old girl - who underwent an appendectomy 8 years ago - with abdominal pain during the last 2 weeks. The first ultrasound examinations were carried out in Austria with normal results. In our department, the ultrasonography and the MR examinations showed an inhomogeneous abdominal mass which was connected to the abdominal wall and with the suspicion of inflammation. Because of the diversified results of radiology imaging and laboratory test, inflammatory bowel disease and tumor were considered in the differential diagnosis. During the operation, a tumor-like lesion related to the ascending colon was found. The histopathological examination revealed a foreign body type suture granuloma with a central abscess. Malignancy was not found. The clinical investigation proved celiac disease, too. The Schloffer tumor is a rare complication after abdominal surgery. This is a foreign body type inflammatory granuloma mainly around a surgical thread. The knowledge of the entity is important in differential diagnostic aspect. The presence of celiac disease in combination with the negative result of the first ultrasound examination made the exact diagnosis more difficult. Orv Hetil. 2021; 162(3): 112-115.