A Case Report on Chronic Xanthogranulomatous Cholecystitis

James Crisfil Fructuoso Montesa; Jacklyn Manaog So-Cabahug

doi:doi:10.11648/j.ijg.20210502.17

| Peer-Reviewed

A Case Report on Chronic Xanthogranulomatous Cholecystitis

James Crisfil Fructuoso Montesa, Jacklyn Manaog So-Cabahug

Published in International Journal of Gastroenterology (Volume 5, Issue 2)

Received: 20 October 2021 Accepted: 12 November 2021 Published: 23 November 2021

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis often being misdiagnosed as gallbladder carcinoma, hence poses as a diagnostic challenge for physicians. The proposed mechanism of the formation of this lesion is through mucosal ulceration or the rupture of Rokitansky-Aschoff sinuses due to increased intraluminal pressure. This causes granulomatous changes that lead to the formation of intramural nodules. Due to its nature of presenting as a gallbladder mass, certain surgical interventions can become unwarranted, which may diminish the patient’s quality of life. This paper presents a case of a 59-year-old male who presented with epigastric pain, initially treated as reflux disease, relieved by antacids, antispasmodics and opioid analgesics. The imaging studies revealed a mass in the gallbladder with signs of cholecystitis. The patient underwent intra-operative ultrasound, extended cholecystectomy and lymph node dissection with an unremarkable postoperative course. The final histopathology revealed chronic xanthogranulomatous cholecystitis and was negative for malignancy. This paper further reviews the presentation of the lesion under different imaging modalities. On ultrasound, it appears as a hypoechoic focus and marked or focal thickening of the gallbladder wall, while on computed tomography, it presents with hypoattenuating nodules in thickened walls, luminal surface enhancement with continuous mucosal lines. While on magnetic resonance imaging, it may appear as either a reduced signal intensity on out of phase images or slightly high signal intensity and slight enhancement on early phase and strong enhancement on the late phase. In general, the recommended treatment approach is through open cholecystectomy.

Published in	International Journal of Gastroenterology (Volume 5, Issue 2)
DOI	10.11648/j.ijg.20210502.17
Page(s)	80-85
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Xanthogranulomatous Cholecystitis, Gallbladder, Case Report

References

[1]	Guzmán-Valdivia G. Xanthogranulomatous cholecystitis: 15 years' experience. World J Surg. 2004 Mar; 28 (3): 254-7. doi: 10.1007/s00268-003-7161-y. Epub 2004 Feb 17. PMID: 14961199.
[2]	Hale MD, Roberts KJ, Hodson J, Scott N, Sheridan M, Toogood GJ. Xanthogranulomatous cholecystitis: a European and global perspective. HPB (Oxford). 2014 May; 16 (5): 448-58. doi: 10.1111/hpb.12152. Epub 2013 Aug 29. PMID: 23991684; PMCID: PMC4008163.
[3]	Krishna RP, Kumar A, Singh RK, Sikora S, Saxena R, Kapoor VK. Xanthogranulomatous inflammatory strictures of extrahepatic biliary tract: presentation and surgical management. J Gastrointest Surg 2008; 12: 836-841.
[4]	Kawana T, Suita S, Arima T, Hirayama Y, Ishii K, Minamishima I, et al. Xanthogranulomatous cholecystitis in an infant with obstructive jaundice. Eur J Pediatr 1990; 149: 765-767.
[5]	Kawate S, Ohwada S, Ikota H, Hamada K, Kashiwabara K, Morishita Y. Xanthogranulomatous cholangitis causing obstructive jaundice: a case report. World J Gastroenterol 2006; 12: 4428-4430.
[6]	Lee KC, Yamazaki O, Horii K, Hamba H, Higaki I, Hirata S, et al. Mirizzi syndrome caused by xanthogranulomatous cholecystitis: report of a case. Surg Today 1997; 27: 757-761.
[7]	Martins PN, Sheiner P, Facciuto M. Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis. Hepatobiliary Pancreat Dis Int. 2012 Oct; 11 (5): 549-52. doi: 10.1016/s1499-3872(12)60223-9. PMID: 23060404.
[8]	Solmaz Tuncer A, Gürel S, Coşgun Z, Büber A, Cakmaz R, Hasdemir OA. A Rare Presentation of Xanthogranulomatous Cholecystitis as Bouveret's Syndrome. Case Rep Radiol. 2012; 2012: 402768. doi: 10.1155/2012/402768. Epub 2012 Dec 30. PMID: 23346444; PMCID: PMC3546451.
[9]	Adachi Y, Iso Y, Moriyama M, Kasai T, Hashimoto H. Increased serum CA19-9 in patients with xanthogranulomatous cholecystitis. Hepatogastroenterology 1998; 45: 77-80.
[10]	Singh, V. P., Rajesh, S., Bihari, C., Desai, S. N., Pargewar, S. S., & Arora, A. (2016). Xanthogranulomatous cholecystitis: What every radiologist should know. World journal of radiology, 8 (2), 183–191.
[11]	Suzuki H, Wada S, Araki K, Kubo N, Watanabe A, Tsukagoshi M, Kuwano H. Xanthogranulomatous cholecystitis: Difficulty in differentiating from gallbladder cancer. World J Gastroenterol. 2015 Sep 21; 21 (35): 10166-73. doi: 10.3748/wjg.v21.i35.10166. PMID: 26401081; PMCID: PMC4572797.
[12]	Parra JA, Acinas O, Bueno J, Güezmes A, Fernández MA, Fariñas MC. Xanthogranulomatous cholecystitis: clinical, sonographic, and CT findings in 26 patients. AJR Am J Roentgenol. 2000 Apr; 174 (4): 979-83. doi: 10.2214/ajr.174.4.1740979. PMID: 10749233.
[13]	Kim PN, Ha HK, Kim YH, Lee MG, Kim MH, Auh YH. US findings of xanthogranulomatous cholecystitis. Clin Radiol. 1998 Apr; 53 (4): 290-2. doi: 10.1016/s0009-9260(98)80129-3. PMID: 9585046.
[14]	Goshima, Satoshi, et al. "Xanthogranulomatous Cholecystitis: Diagnostic Performance of CT to Differentiate From Gallbladder Cancer." European Journal of Radiology, vol. 74, no. 3, 2010, pp. e79-83.
[15]	Zhao F, Lu PX, Yan SX, et al. CT and MR features of xanthogranulomatous cholecystitis: an analysis of consecutive 49 cases. European Journal of Radiology. 2013 Sep; 82 (9): 1391-1397. DOI: 10.1016/j.ejrad.2013.04.026. PMID: 23726123.
[16]	Shuto R, Kiyosue H, Komatsu E, Matsumoto S, Kawano K, Kondo Y, Yokoyama S, Mori H. CT and MR imaging findings of xanthogranulomatous cholecystitis: correlation with pathologic findings. Eur Radiol 2004; 14: 440-446 [PMID: 12904879].
[17]	Feng L, You Z, Gou J, Liao E, Chen L. Xanthogranulomatous cholecystitis: experience in 100 cases. Ann Transl Med. 2020 Sep; 8 (17): 1089. doi: 10.21037/atm-20-5836. PMID: 33145308; PMCID: PMC7575994.
[18]	National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. 2021, November 11.
[19]	Rahman J, Tahir M, Sonawane S (August 25, 2020) Xanthogranulomatous Cholecystitis: A Diagnostic Challenge for Radiologists, Surgeons, and Pathologists. Cureus 12 (8): e10007. doi: 10.7759/cureus.10007.
[20]	Nacif LS, Hessheimer AJ, Rodríguez Gómez S, Montironi C, Fondevila C. Infiltrative xanthogranulomatous cholecystitis mimicking aggressive gallbladder carcinoma: A diagnostic and therapeutic dilemma. World J Gastroenterol. 2017; 23 (48): 8671-8678. doi: 10.3748/wjg.v23.i48.8671.

Cite This Article

Plain Text BibTeX RIS

APA Style

James Crisfil Fructuoso Montesa, Jacklyn Manaog So-Cabahug. (2021). A Case Report on Chronic Xanthogranulomatous Cholecystitis. International Journal of Gastroenterology, 5(2), 80-85. https://doi.org/10.11648/j.ijg.20210502.17

Copy | Download

ACS Style

James Crisfil Fructuoso Montesa; Jacklyn Manaog So-Cabahug. A Case Report on Chronic Xanthogranulomatous Cholecystitis. Int. J. Gastroenterol. 2021, 5(2), 80-85. doi: 10.11648/j.ijg.20210502.17

Copy | Download

AMA Style

James Crisfil Fructuoso Montesa, Jacklyn Manaog So-Cabahug. A Case Report on Chronic Xanthogranulomatous Cholecystitis. Int J Gastroenterol. 2021;5(2):80-85. doi: 10.11648/j.ijg.20210502.17

Copy | Download

@article{10.11648/j.ijg.20210502.17,
  author = {James Crisfil Fructuoso Montesa and Jacklyn Manaog So-Cabahug},
  title = {A Case Report on Chronic Xanthogranulomatous Cholecystitis},
  journal = {International Journal of Gastroenterology},
  volume = {5},
  number = {2},
  pages = {80-85},
  doi = {10.11648/j.ijg.20210502.17},
  url = {https://doi.org/10.11648/j.ijg.20210502.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20210502.17},
  abstract = {Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis often being misdiagnosed as gallbladder carcinoma, hence poses as a diagnostic challenge for physicians. The proposed mechanism of the formation of this lesion is through mucosal ulceration or the rupture of Rokitansky-Aschoff sinuses due to increased intraluminal pressure. This causes granulomatous changes that lead to the formation of intramural nodules. Due to its nature of presenting as a gallbladder mass, certain surgical interventions can become unwarranted, which may diminish the patient’s quality of life. This paper presents a case of a 59-year-old male who presented with epigastric pain, initially treated as reflux disease, relieved by antacids, antispasmodics and opioid analgesics. The imaging studies revealed a mass in the gallbladder with signs of cholecystitis. The patient underwent intra-operative ultrasound, extended cholecystectomy and lymph node dissection with an unremarkable postoperative course. The final histopathology revealed chronic xanthogranulomatous cholecystitis and was negative for malignancy. This paper further reviews the presentation of the lesion under different imaging modalities. On ultrasound, it appears as a hypoechoic focus and marked or focal thickening of the gallbladder wall, while on computed tomography, it presents with hypoattenuating nodules in thickened walls, luminal surface enhancement with continuous mucosal lines. While on magnetic resonance imaging, it may appear as either a reduced signal intensity on out of phase images or slightly high signal intensity and slight enhancement on early phase and strong enhancement on the late phase. In general, the recommended treatment approach is through open cholecystectomy.},
 year = {2021}
}

Copy | Download

TY - JOUR
T1 - A Case Report on Chronic Xanthogranulomatous Cholecystitis
AU - James Crisfil Fructuoso Montesa
AU - Jacklyn Manaog So-Cabahug
Y1 - 2021/11/23
PY - 2021
N1 - https://doi.org/10.11648/j.ijg.20210502.17
DO - 10.11648/j.ijg.20210502.17
T2 - International Journal of Gastroenterology
JF - International Journal of Gastroenterology
JO - International Journal of Gastroenterology
SP - 80
EP - 85
PB - Science Publishing Group
SN - 2640-169X
UR - https://doi.org/10.11648/j.ijg.20210502.17
AB - Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis often being misdiagnosed as gallbladder carcinoma, hence poses as a diagnostic challenge for physicians. The proposed mechanism of the formation of this lesion is through mucosal ulceration or the rupture of Rokitansky-Aschoff sinuses due to increased intraluminal pressure. This causes granulomatous changes that lead to the formation of intramural nodules. Due to its nature of presenting as a gallbladder mass, certain surgical interventions can become unwarranted, which may diminish the patient’s quality of life. This paper presents a case of a 59-year-old male who presented with epigastric pain, initially treated as reflux disease, relieved by antacids, antispasmodics and opioid analgesics. The imaging studies revealed a mass in the gallbladder with signs of cholecystitis. The patient underwent intra-operative ultrasound, extended cholecystectomy and lymph node dissection with an unremarkable postoperative course. The final histopathology revealed chronic xanthogranulomatous cholecystitis and was negative for malignancy. This paper further reviews the presentation of the lesion under different imaging modalities. On ultrasound, it appears as a hypoechoic focus and marked or focal thickening of the gallbladder wall, while on computed tomography, it presents with hypoattenuating nodules in thickened walls, luminal surface enhancement with continuous mucosal lines. While on magnetic resonance imaging, it may appear as either a reduced signal intensity on out of phase images or slightly high signal intensity and slight enhancement on early phase and strong enhancement on the late phase. In general, the recommended treatment approach is through open cholecystectomy.
VL - 5
IS - 2
ER -

Copy | Download

Author Information

James Crisfil Fructuoso Montesa

Section of Gastroenterology and Digestive Endoscopy, Manila Doctors Hospital, Manila, Philippines
Jacklyn Manaog So-Cabahug

Section of Gastroenterology and Digestive Endoscopy, Manila Doctors Hospital, Manila, Philippines

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

James Crisfil Fructuoso Montesa, Jacklyn Manaog So-Cabahug. (2021). A Case Report on Chronic Xanthogranulomatous Cholecystitis. International Journal of Gastroenterology, 5(2), 80-85. https://doi.org/10.11648/j.ijg.20210502.17

Copy | Download

ACS Style

James Crisfil Fructuoso Montesa; Jacklyn Manaog So-Cabahug. A Case Report on Chronic Xanthogranulomatous Cholecystitis. Int. J. Gastroenterol. 2021, 5(2), 80-85. doi: 10.11648/j.ijg.20210502.17

Copy | Download

AMA Style

James Crisfil Fructuoso Montesa, Jacklyn Manaog So-Cabahug. A Case Report on Chronic Xanthogranulomatous Cholecystitis. Int J Gastroenterol. 2021;5(2):80-85. doi: 10.11648/j.ijg.20210502.17

Copy | Download

@article{10.11648/j.ijg.20210502.17,
  author = {James Crisfil Fructuoso Montesa and Jacklyn Manaog So-Cabahug},
  title = {A Case Report on Chronic Xanthogranulomatous Cholecystitis},
  journal = {International Journal of Gastroenterology},
  volume = {5},
  number = {2},
  pages = {80-85},
  doi = {10.11648/j.ijg.20210502.17},
  url = {https://doi.org/10.11648/j.ijg.20210502.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20210502.17},
  abstract = {Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis often being misdiagnosed as gallbladder carcinoma, hence poses as a diagnostic challenge for physicians. The proposed mechanism of the formation of this lesion is through mucosal ulceration or the rupture of Rokitansky-Aschoff sinuses due to increased intraluminal pressure. This causes granulomatous changes that lead to the formation of intramural nodules. Due to its nature of presenting as a gallbladder mass, certain surgical interventions can become unwarranted, which may diminish the patient’s quality of life. This paper presents a case of a 59-year-old male who presented with epigastric pain, initially treated as reflux disease, relieved by antacids, antispasmodics and opioid analgesics. The imaging studies revealed a mass in the gallbladder with signs of cholecystitis. The patient underwent intra-operative ultrasound, extended cholecystectomy and lymph node dissection with an unremarkable postoperative course. The final histopathology revealed chronic xanthogranulomatous cholecystitis and was negative for malignancy. This paper further reviews the presentation of the lesion under different imaging modalities. On ultrasound, it appears as a hypoechoic focus and marked or focal thickening of the gallbladder wall, while on computed tomography, it presents with hypoattenuating nodules in thickened walls, luminal surface enhancement with continuous mucosal lines. While on magnetic resonance imaging, it may appear as either a reduced signal intensity on out of phase images or slightly high signal intensity and slight enhancement on early phase and strong enhancement on the late phase. In general, the recommended treatment approach is through open cholecystectomy.},
 year = {2021}
}

Copy | Download