Xanthogranulomatous Cholecystitis: Analysis of 108 Patients

Abstract

The aim of this study was to evaluate the clinical and radiological features of xanthogranulomatous cholecystitis (XGC) and the results of surgical treatment. This retrospective study concerns clinical, radiological, and surgical data as well as histopathological findings and postoperative results of 108 patients with XGC who were identified after evaluating 7916 cholecystectomy specimens between 2004 and 2014 in a single institute. One hundred eight patients with XGC were evaluated (56 males and 52 females, mean age 62.3 years). Clinical findings at referral included acute and chronic cholecystitis, Mirizzi's syndrome, choledocholithiasis, cholangitis, and acute pancreatitis. Ultrasound was performed in all patients, CT in 25, contrast-enhanced MRI in 29, and magnetic resonance cholangiopancreatography (MRCP) in 25 patients. None of the patients were diagnosed preoperatively, but mild-moderate degrees of wall thickening were present in most. Fifty-four patients received open cholecystectomy, while 54 received laparoscopic intervention, among whom 23 were converted to open. Partial cholecystectomy was performed in 11 patients. Two patients with gallbladder adenocarcinoma were treated with radical cholecystectomy. XGC has nonspecific clinical and radiological findings; thus, preoperative diagnosis is generally absent. Open cholecystectomy is the recommended treatment modality. Conversion to open is frequently necessary after laparoscopy. Complete cholecystectomy is the ultimate goal; however, partial cholecystectomy may be preferred to protect the structures of the hepatic hilum.

Ksantogranülomatöz kolesistitin cerrahi üzerine etkisi

“…Yücel et al did not emphasize the relationship between conditions causing biliary stasis and XGC in their study. However, they reported that 13.8% of the patients had ERCP, 11.1% had choledocholithiasis, 4.6% had cholangitis, and 4.6% had acute pancreatitis in the preoperative period 7 . In our study, pathologies that may lead to extrahepatic bile duct obstruction were observed in patients diagnosed with XGC 4,6 .…”

Diagnostic and surgical dilemma of cholecystitis that mimics cancer – A case report of xanthogranulomatous cholecystitis

“…Clinical presentation of XGC is variable and often non-specific. A majority of patients present with chronic cholecystitis while others have acute cholecystitis or Mirizzi’s syndrome [ 8 , 11 ]. Almost all patients with XGC report abdominal pain, while nausea, vomiting, and anorexia occur in 18%–38% of patients [ 4 ].…”

“…XGC is thought to result from mucosal ulceration or rupture of occluded Rokitansky-Aschoff sinuses, followed by intramural extravasation of inspissated bile and mucin [ 3 , 11 ]. This can be caused by elevated intraluminal pressure secondary to gallbladder or cystic duct obstruction.…”

“…Extravasation of bile and mucin further attracts histiocytes that phagocytize insoluble cholesterol and bile salts, resulting in characteristic macrophage-laden and foamy histiocytes. In response, a chronic granulomatous inflammatory process leads to gallbladder wall thickening that can be mistaken for carcinoma [ 3 , 11 ]. Inflammation and rupture of the gallbladder serosal lining and the resulting fibrous reaction and scar formation lead to adhesions to neighbouring tissues including the liver, colon, and duodenum.…”

Cholecysto-colonic fistula after xanthogranulomatous cholecystitis: Surgeon’s nightmare

“…Intramural accumulation of lipid-laden macrophages and acute and chronic in lammatory cells is the hallmark of the disease. The xanthogranulomatous in lammation can be very severe and can spill over to the neighboring structures like liver, bowel and stomach resulting in dense adhesions, abscess formation, perforation, and istulous communication with adjacent bowel [1][2][3]. Cholecysto-colic istula is a rare and late complication of gallstones roughly found 1 in every 1,000 cholecystectomies.…”