Premium
HP30P
XANTHOGRANULOMATOUS CHOLECYSTITIS: A CLINICOPATHOLOGICAL STUDY FROM A TERTIARY CARE HEALTH INSTITUTION
Author(s) -
Shenoy R.,
Rodrigues G. S.,
Rao A.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04920_30.x
Subject(s) - medicine , cholecystectomy , cholecystostomy , gallstones , cholecystitis , malignancy , gallbladder , general surgery , surgery , laparoscopic cholecystectomy , chronic cholecystitis
Background: Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive form of chronic cholecystitis and is indistinguishable from other forms of cholecystitis. Objectives: To review the demographic and clinical aspects of XGC; to study the possibility of preoperative diagnosis and to identify the causes for difficult surgery. Materials and Methods: Cases histopathologically diagnosed as XGC over a period of six years from October 1999 to September 2005 were included in the study. Results: A total of 615 patients underwent cholecystectomy out of which 33 (5.2%) were diagnosed to have XGC. USG showed gallbladder wall thickening in 19 (57.5%) cases and gallstones in 32 (96.9%). Thirty (90.9%) underwent open cholecystectomy. Gallbladder could be removed totally in 25 (75.6%) cases whereas five (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 five (15.1%) patients and one (3%) had minor biliary leak which was treated conservatively. Histologically, XGC was associated with malignancy in one (3.03%) patient. There was no mortality. Conclusion: Clinical presentation of XGC was indistinguishable from chronic cholecystitis. USG reveal only non‐specific findings of calculi and thickened gall bladder wall. Hence preoperative diagnosis is unlikely. Cholecystectomy was usually difficult owing to dense adhesions of gallbladder and Calot's triangle. Conversion rate of laparoscopic cholecystectomy is higher. Morbidity associated with surgery is significant.