Mobile surgical clip granuloma - "clipoma"

Case contributed by Pramod Gupta
Diagnosis almost certain


History of chronic renal failure underwent routine CT scans to evaluate his renal transplant. The patient also had a remote history of small bowel surgery 35 years ago. An interesting incidental finding was noticed on sequential CT scans.

Patient Data

Age: 65 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

On initial CT, a large oval 6 x 5 cm circumscribed smooth innocuous mass is present in left deep inguinal fossa (arrows). The mass had a surgical clip in the center. 

On subsequent CT obtained two years later, mass has moved to posterior deep pelvis (arrows). The bone window (third image) better depicts the surgical clip in the center (arrowhead).

Case Discussion

Amputated appendices epiploicae account for the vast majority of free peritoneal bodies (also known as peritoneal loose bodies or peritoneal mice). Other differential diagnoses for peritoneal loose bodies include dropped gallstone, foreign body including surgical clip, fecalith, calcified dermoid, calcified echinococcal cyst, calcified uterine/gastric leiomyoma and spontaneous amputated ovary.  Although dropped surgical clips have been known to be peritoneal loose bodies, the surgical clip granuloma presenting as a peritoneal loose body is quite rare.

Usually, the peritoneal loose bodies are innocuous and not clinically significant. There have been few case reports where peritoneal loose bodies were the etiology of urinary retention, bowel obstruction and chronic abdominal pain. The management of symptomatic loose bodies is usually surgical removal via laparoscopy.

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