Duodenal Diverticulum Causing Xanthogranulomatous Pyelonephritis with Multiorgan Involvement: First Case Report

XGP is a rarely described chronic inflammatory process characterized by partial or full destruction of the kidney and replacement by granulomatous tissue containing foamy, lipid-laden macrophages Dear Sir, Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive inflammatory process which very rarely originates from the digestive tract. A previously healthy 40-year-old female patient presented with an asymptomatic abdominal mass. Physical examination revealed a 10 ! 15 cm tumor in the right hypochondrium which was non-tender and fixed to the liver. All laboratory tests were within normal limits. An abdominal CT scan showed a solitary multiloculated mass involving the proximal kidney and right hepatic lobe ( fig. 1 ). Abdominal exploration revealed a 14 ! 12 cm firm mass infiltrating the proximal third of kidney, duodenum, and Couinaud segment VI of the liver. Dissection posterior to D3 found a 1.5 ! 0.8 cm duodenal diverticulum which widely communicated with the necrotic center of the tumor. A radical nephrectomy, liver segmentectomy VI, and excision of the diverticulum produced a whole specimen which was sent for pathology. The resulting defect of the duodenal wall was anatomically restored in two layers. Pathology revealed XGP with extensive infiltration of the liver parenchyma and no malignancy. The patient was last seen 4 months after surgery and had no complaints; all laboratory tests remained within normal limits. Published online: March 20, 2007