Publication: Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution
Date
2008
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Abstract
Background: Xanthogranulomatous cholecystitis is an unusual and destructive form of chronic cholecystitis and is
indistinguishable from other forms of cholecystitis which makes preoperative diagnosis and surgery dif cult.
Objectives: To review the demographic and clinical aspects of xanthogranulomatous cholecystitis; to study the possibility
of preoperative diagnosis and to identify the causes for dif cult surgery.
Materials and methods: All cases histopathologically diagnosed as xanthogranulomatous cholecystitis over a period of
six years from October 1999 to September 2005 at Kasturba Medical College Hospital, Manipal, India were included in
the study. Data of the patients was collected retro and prospectively.
Results: A total of 615 patients underwent cholecystectomy out of which 33 (5.2%) were diagnosed to have
xanthogranulomatous cholecystitis. Ultrasound abdomen showed gallbladder wall thickening in 19 (57.5%) cases and
gallstones in 32 (96.9%) cases. Thirty (90.9%) underwent open cholecystectomy. Gallbladder could be removed totally in
25 (75.6%) cases whereas ve (15.2%) had to undergo partial cholecystectomy and in one patient, only cholecystostomy
could be performed due to dense adhesions. Laparoscopic cholecystectomy was attempted in 11 patients but successful
only in two patients with a conversion rate of 81.8%. Postoperative wound infection was seen in ve (15.1%) patients
and one (3%) had minor biliary leak which was treated conservatively. Histologically, xanthogranulomatous cholecystitis
was associated with malignancy in one (3.03%) patient. There was no mortality.
Conclusion: Clinical presentation of xanthogranulomatous cholecystitis was indistinguishable from chronic cholecystitis.
Ultrasonography may reveal only non speci c ndings of calculi and thickened gall bladder wall. Hence preoperative
diagnosis is unlikely. Cholecystectomy was usually dif cult owing to dense adhesions of gallbladder and Calot’s triangle.
Conversion rate of laparoscopic cholecystectomy is higher. Morbidity associated with surgery is signi cant.
Key words: Xanthogranulomatous cholecystitis, Cholecystectomy, Malignancy.
Description
Kansakar PBS1, Rodrigues G2, Khan SA3
1,2 Department of General Surgery, Kasturba Medical College, 3 Faculty, Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India