Xanthogranulomatous Cholecystitis: A Rare Variant of Chronic Cholecystitis

Abstract

Gallbladder disease is a very common condition that encompasses a heterogeneous group of diseases with a wide range of severity and clinical manifestations. Gallbladder disorders include biliary colic, acute cholecystitis, chronic cholecystitis, choledocholithiasis, Mirizzi syndrome, and gallstone ileus. We report the case of a 70-year-old man who presented to the emergency department complaining of worsening abdominal pain, located in the right upper quadrant and radiating to the right shoulder. It was aggravated by food intake and relieved with the use of antacid medications. The medical history of the patient was significant for stable angina, hypertension, diabetes mellitus, hyperlipidemia, and sickle cell trait. Examination of the abdomen revealed generalized tenderness with guarding. Abdominal computed tomography scan demonstrated the presence of significant diffuse thickening of the gallbladder wall with poor contrast enhancement. Complete resection of the gallbladder was performed because of suspected gallbladder carcinoma. Histopathological examination revealed xanthogranulomatous cholecystitis, which is a rare form of chronic cholecystitis. The differentiation between gallbladder carcinoma and xanthogranulomatous cholecystitis may not be easy and histopathological examination is the most accurate way to make the diagnosis.

Gallbladder Cancer or Diffuse Xanthogranulomatous Cholecystitis: A Case of Management Dilemma During Elective Cholecystectomy With Unexpected Severe Mass-Like Pericholecystic Fibrosis and Inflammation

“…Helpful approaches include CT, MRI, biopsy, and evaluation of tumor markers. Laparoscopic cholecystectomy has shown to be the gold-standard therapy for benign gallbladder disease and is also the standard treatment for XC [ 11 ]. However, the extent of the inflammation and adhesions often seen in patients with XC, leads conversion of surgeries from laparoscopy to open in nearly a third of the cases (26%) [ 18 ].…”

“…Diffuse XC can present with a wide spectrum of otherwise nonspecific symptoms including fevers, nausea, vomiting, jaundice, right upper quadrant pain postprandial pain, and in some cases presents with weight loss in patients [10][11][12][13]. The natural history and biology of diffuse XC make it virtually indistinguishable from that of GC [13,14].…”

Altered microbiome of serum exosomes in patients with acute and chronic cholecystitis

“…The age range of the participants varied from 26 to 71 years old. In the Acute group, the average age of patients was (51 ± 11) years, with a white blood cell (WBC) count of (8.83 ± 3.43)×10 9 /L and C-reactive protein (CRP) levels of (24.02 ± 41.45) mg/L. In the Chronic group, the average age of patients was (45 ± 12) years, with a WBC count of (6.65 ± 2.06)×10 9 /L and CPR levels of (1.21 ± 0.88) mg/L.…”

“…Chronic cholecystitis, on the other hand, is a prevalent chronic gastrointestinal disorder, accounting for 60-80% of all cholecystitis cases. Its main symptoms include periodic or persistent mild to moderate pain [8][9][10]. While the prognosis for chronic cholecystitis is generally favorable, prolonged inflammation and damage may increase the risk of developing gallbladder cancer [11].…”