Granulomatous cholecystitis in a patient with schistosoma mansoni infection: A case report

Abstract

Introduction: Schistosomal cholecystitis is remarkably uncommon. Almost all of the reported cases in literature, less than eleven universally, are associated with concomitant gallstone disease. It is unclear whether the extensive fibrocalcific reaction of the bladder`s wall and the cystic duct, seen in all cases, predisposes to cholelithiasis, or gallstones coexist. Case report: We report a Greek patient who developed schistosomal granulomatous lithiasic cholecystitis, which is unique in Greek medical chronicles. Performing a safe cholecystectomy in this patient was extremely difficult due to badly inflamed gallbladder. Conclusion: Schistosoma infection is associated with chronic granulomatous inflammation making cholecystectomy difficult and unsafe. In this article, we focus especially on prevention of bile duct injury by being prepared that a patient with a possible schistosomal cholecystitis will present with a complicated case.

First Schistosomal Cholecystitis Complicated by Cholangitis and Liver Abscess: Case Report and Review of Literature

“…Moreover, four patients received postoperative complementary medical treatment which was praziquantel [8,15,19]. Similar to others, our patient received postoperative praziquantel.…”

Schistosomiasis as a cause of acute cholecystitis

“… 5 Patients having hepatosplenic schistosomiasis are found to have certain ultrasonographic abnormalities such as calcification and thickening of the wall with reduced volume in the gallbladder, as could be seen in our case. 6 A very few international reports showed a rare histopathological finding of a granulomatous cholecystitis with schistosomal egg deposition, like that observed in the present case, hence being a rare finding. However, recognizing the disease as schistosomal cholecystitis is a debatable conclusion because a variety of different disease like X-linked chronic granulomatous disease, Crohn’s disease, xanthogranulomatous cholecystitis, fibroelastosis of the gallbladder and infection with Mycobacterium tuberculosis and Candida glabrata may also cause granulomatous cholecystitis.…”

Rare presentation of gallbladder schistosomiasis: a case report

“…However, granulomatous changes are not limited to schistosomiasis; the differential diagnoses include xanthogranulomatous cholecystitis, Crohn's disease, X-linked chronic granulomatous disease, and cancer. 9,11,[16][17][18][19] Most cases of gallbladder schistosomiasis are managed by laparoscopic surgery. Surgeons should consider the possibility of schistosomiasis when managing patients with cholecystitis and should be prepared for worst-case scenarios.…”

“…5 , 8 Symptoms of gallbladder schistosomiasis are not specific to Schistosoma infection; nevertheless, it includes features of the typical presentation of other gallbladder pathologies, such as right upper quadrant pain that might radiate to the right shoulder and general symptoms such as nausea, vomiting, or diarrhea. 9 , 10 On physical examination, abdominal tenderness is the most commonly reported symptom, 6 , 10 , 11 and a positive Murphy’s sign has also been reported. 6 In our case, the initial presentation was abdominal distension; during the second visit, the patient reported abdominal pain, low-grade fever, difficulty breathing, fatigue, and diarrhea.…”