Uncommon Presentation of Xanthogranulomatous Cholecystitis in a True Gallbladder Diverticulum: A Case Report and Literature Review

Abstract

Patient: Female, 38-year-old Final Diagnosis: True gallbladder diverticulum Symptoms: Right upper quadrant (RUQ) pain Clinical Procedure: — Specialty: Pathology • Surgery Objective: Rare coexistence of disease or pathology Background: The gallbladder develops from the hepatic diverticulum during the fourth week of gestation, which also give rise to the liver, extrahepatic biliary ducts, and ventral part of the pancreas. Infrequently, the gallbladder has malformation or disruption in embryogenesis, leading to congenital anomalies. There are various congenital anomalies that can arise in the gallbladder. True or congenital diverticulum of the gallbladder is a rare entity that accounts for only 0.06% of gallbladder congenital anomalies and 0.0008% of cholecystectomies at the Mayo Clinic. Case Report: Herein, we report a rare case of a 38-year-old woman who presented to Jubail General Hospital’s surgery clinic with right upper-quadrant (RUQ) pain associated with vomiting after meals for 1 month. Laparoscopic cholecystectomy was done and gallbladder tissue was sent to histopathology. Gross examination revealed an outpouching mucosa within the wall that was proven to consist of muscularis and serosa layers under light microscope. Interestingly, xanthogranulomatous inflammation was confined to the diverticulum, unlike the chronic inflammation involving the remaining gallbladder. Based on the above findings, the diagnosis of congenital diverticulum with xanthogranulomatous cholecystitis was made. Conclusions: Gallbladders associated with a true diverticulum are uncommonly found to be buried in the liver, leading to surgical difficulties during cholecystectomy. Therefore, background knowledge of occasional anomalies plays a crucial role in guiding the surgeon to choose the optimal method of management. We also discuss the associated complications that accompany these anomalies, such as non-specific prolonged ailments, acalculous cholecystitis, cholecystitis and cholelithiasis, recurrent cholangitis, and carcinoma of the gallbladder.

Gallbladder Diverticulum as a Rare Disease and a Therapeutic Challenge: A Case Report

“…Gallbladder diverticulum is a rare and often underreported anatomical anomaly that presents significant diagnostic and therapeutic challenges [1,[4][5][6]. This condition is characterized by the herniation of the gallbladder mucosa through the muscular layer, forming either a true (congenital) diverticulum, which includes all layers of the gallbladder wall, or a false (acquired) diverticulum, which lacks a complete wall structure [4].…”

“…Clinically, patients with gallbladder diverticula may be asymptomatic or present with symptoms that mimic cholecystitis, such as right upper quadrant pain, nausea, and vomiting [1,4,[7][8][9]. This overlap in symptoms can complicate the diagnostic process.…”

“…Characterized by the herniation of the gallbladder mucosa, this condition can manifest with symptoms similar to those of more common gallbladder diseases, complicating the diagnostic process. The pathogenesis of gallbladder diverticula involves a mix of congenital anomalies and acquired factors, with chronic inflammation and increased intraluminal pressure playing pivotal roles [1,4]. This case report explores the atypical clinical presentation of gallbladder diverticulum, emphasizing the complexities of its management and the critical role of timely surgical intervention.…”

“…Gallbladder diverticulum, although rare, presents significant diagnostic and therapeutic challenges in clinical practice [1][2][3][4]. Characterized by the herniation of the gallbladder mucosa, this condition can manifest with symptoms similar to those of more common gallbladder diseases, complicating the diagnostic process.…”