Xanthogranulomatous cholecystitis is a rare variant of chronic
cholecystitis characterized by severe proliferative
fibrosis and accumulation of
lipid-laden macrophages in regions of destructive
inflammation.
Xanthogranulomatous cholecystitis clinically and radiologically mimics early-stage
gallbladder cancer, with wall thickening on computed tomography. The study included 14
xanthogranulomatous cholecystitis patients that were identified following retrospective analysis of the records of 1248 patients that underwent
cholecystectomy between 2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years. All 14 patients had gallbladder stones; 10 had a history of
acute cholecystitis, 1 had
cholangitis, and 2 presented with
obstructive jaundice. A right-upper quadrant mass was palpable in 2 patients. All patients underwent
cholecystectomy. Open surgery was planned and performed in 6 of the 14 patients, and
laparoscopic cholecystectomy was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1 patient developed
wound infection, 1 patient had postoperative
pneumonia, and 1 patient developed intraabdominal
hematoma. None of the patients in the series died.
Xanthogranulomatous cholecystitis is difficult to diagnose, both preoperatively and intraoperatively, and definitive diagnosis depends exclusively on pathological examination.
Xanthogranulomatous cholecystitis should be a consideration in all difficult
cholecystectomy cases.