Symptomatic injection granuloma of buttock and management with ultrasound-guided barbotage procedure

Injection granulomas (IGs) are recognized as a consequence of the injection of injectates into adipose tissue after routine drug or vaccine injections without reaching the muscular tissue. A series of reactions of the injectates in adipose tissue results in necrotic tissue and deposition of calcium crystals. IGs are usually asymptomatic but may rarely be symptomatic. In the past, symptomatic cases were mostly managed conservatively or surgically. However, to the best of our knowledge, no procedure other than surgical or conservative treatment has been reported. A 57-year-old patient with a history of multiple intramuscular diclofenac injections presented with localized right buttock pain for 8 months. The patient, who did not respond to conservative treatment, underwent an ultrasound-guided barbotage procedure commonly used in the diagnosis of calcific periarthritis. The patient's pain complaint was evaluated according to the visual analog scale (VAS). The patient reported VAS:7 before the barbotage procedure and VAS:2 at the sixth week follow-up after the barbotage procedure. This case report, provided that it is supported by future studies, suggests that the ultrasound-guided barbotage procedure, which is commonly used in patients with calcific periarthritis, may be a promising treatment method in IG cases unresponsive to conservative treatment.