Summary Ten cases of rice starch granulomatous peritonitis are reported. An analysis of these patients plus a review of the carlier reported cases indicates a characteristic disease pattern of severe abdominal pain occurring two to six weeks after surgery, which is associated with a fulminant peritoneal reaction, ascites, adhesions, and diagnostic presence of starch-containing miliary nodules. It is our opinion that granulomatous peritonitis caused by rice starch powder is a more severe and violent process than that caused by corn starch powder. It is assumed that many less dramatic cases might be responsible for unexplained postoperative complications and delays in recovery. The importance of meticulous removal of powder, regardless of its constitution, from surgical gloves and equipment is imperative in the prevention of this problem.