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A 53-year-old female with a history of hiatal hernia repair presented with right upper quadrant pain and jaundice. Physical examination revealed tenderness of the right upper quadrant. Laboratory tests showed elevated C-reactive protein of 109 mg/L (normal <10) and total bilirubin of 181 μmol/L (normal 0–21). Abdominal computed tomography highlighted a gallstone within the main bile duct and an enlarged gallbladder with heterogenous enhancement and intramural hypoattenuating nodules (Figure A). These radiological features established the diagnosis of xanthogranulomatous cholecystitis (XC). The patient underwent an endoscopic retrograde cholangiopancreatography to remove the gallstone of the main bile duct, while XC was treated with antibiotics. A control abdominal computed tomography showed a good response to antibiotics (Figure B), and the patient underwent laparoscopic cholecystectomy. The postoperative course was uneventful. A pathological analysis confirmed the diagnosis of XC, a subtype of cholecystitis characterized by a marked destructive inflammatory reaction. Its diagnosis is difficult and rarely done preoperatively, but rather based on pathology. XC can mimic other diseases such as gallbladder cancer. Cholecystectomy is the treatment of choice for XC, but it is associated with increased risks of bleeding, conversion, and complications. In summary, clinicians involved in the management of patients with hepatobiliary disorders (eg, gastroenterologists and gastrointestinal surgeons) should be aware of this entity, to facilitate early diagnosis and to improve its management.
Authors' Contributions
Study concept and design: P.D., E.U., I.L. Acquisition of data: P.D., I.L. Analysis and interpretation of data: P.D., E.U., I.L. Drafting of the manuscript: P.D., I.L. Critical revision of the manuscript for important intellectual content: P.D., E.U., I.L.
Conflict of Interest: The authors disclose no conflicts.
Funding: The authors report no funding.
Ethical Statement: The corresponding author, on behalf of all authors, jointly and severally, certifies that their institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.
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