Morbidity and Mortality in Talc Granuloma: Report of a Fatal Case

Our plain-English summary of Morbidity and Mortality in Talc Granuloma: Report of a Fatal Case, by A.J. Swingle (Annals of Surgery, 1948).

The study

• Author: A.J. Swingle
• Journal: Annals of Surgery
• Published: 1948;128(1):144-52
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003320).

In plain English

This 1948 article reported one fatal case of talc granuloma, a reaction to talcum powder used on surgical gloves and rubber drains. The patient, a woman, was first operated on in December 1942, at age 36, for intestinal obstruction, and an adenocarcinoma of the descending colon was found. The article counted the operations inconsistently, saying both that fifteen were performed and that 15 followed the first; the author attributed these to intestinal obstruction from adhesions ascribed to talc granuloma. Only the last two operations were at the Veterans Hospital in Wood, Wisconsin. She died on the 86th postoperative day after her final operation. At autopsy, the cause of death was inanition (starvation) due to chronic adhesive peritonitis. The autopsy also found diffuse talc granulomatosis of the peritoneal surfaces and no sign that the cancer had returned. Microscopy showed birefringent crystals described as morphologically identical with talc crystals. Slides from a resection about three months after the first operation, read elsewhere as a reaction to suture material, could not be re-examined. The author concluded that talcum powder was undoubtedly directly responsible for the death and has no place in modern surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single fatal case, with autopsy), preceded by a review of earlier published reports
• Who was studied: One female patient (A.L.M.), first operated on in December 1942 at age 36 while in the Army; the last two operations were at the Veterans Hospital, Wood, Wisconsin
• Exposure: Talcum powder used as a dusting powder on surgical gloves and rubber drains, entering the abdomen during surgery
• Main results:
  • The article states that fifteen operations were performed in this patient, that she died, and that an autopsy was done
  • The discussion refers to 15 operations after the first, all attributed by the author to intestinal obstruction from adhesions ascribed to talc granuloma, which does not match the earlier total of fifteen
  • The patient died on the 86th postoperative day after her final operation, when measures to control a fistula and maintain nutrition failed
  • At autopsy the cause of death was inanition due to chronic adhesive peritonitis
  • Autopsy findings included diffuse talc granulomatosis of the peritoneal surfaces
  • In the ileum removed in February 1947, polarizing microscopy showed birefringent crystals morphologically identical with talc crystals
  • Mesenteric lymph nodes showed chronic inflammation but no talc crystals
  • No recurrence or spread of the patient's colon cancer was found at autopsy
• The authors' conclusion: The author concluded that talcum powder was undoubtedly directly responsible for this patient's death, that it is a dangerous agent with no place in modern surgery, and that the modified corn starch preparation recommended by Lee and Lehman seemed the best substitute
• Limitations the authors state:
  • The pathology slides from the resection of a stricture at the previous anastomosis, done about three months after the first operation, had been examined elsewhere and attributed to suture material. They could not be re-examined under the polarizing microscope
  • Most of the operations were done while the patient was in the Army; only the last two were done at the reporting hospital
  • The author considered that trauma, infection and the patient's sensitivity to rubber may also have contributed to the severity of the reaction

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc, Granuloma.

Related studies

• Morbidity and mortality in talc-exposed workers — E. Wergeland, A. Andersen, et al. (1990)
• Pulmonary talc granulomatosis. A complication of drug abuse — G.B. Hopkins, D.G. Taylor (1970)
• Pulmonary granulomatous reaction: talc pneumoconiosis or chronic sarcoidosis? — P. Tukiainen, J. Nickels, et al. (1984)
• Mortality of Talc Miners and Millers From Val Chisone, Northern Italy: An Updated Cohort Study — E. Pira, M. Coggiola, et al. (2017)
• Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax — S. Tenconi, L. Luzzi, et al. (2010)
• Morbidity of the abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) — M.F. Nunez, A. Sardi, et al. (2015)

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