Document Type : Research articles

Authors

• Osman Erdogan ¹
• Alper Parlakgumus ²
• Alper Sozutek ³
• Umit Turan ⁴
• Zeynel Abidin Tas ⁵
• Oktay Irkorucu ⁶

¹ MD, Specialist of Surgical Oncology, Department of Surgical Oncology, Adana City Training and Research Hospital, Adana, Turkey

² MD, Associate Professor , Department of Surgical Oncology, Adana City Training and Research Hospital, Adana, Turkey

³ MD, Associate Professor , Department of Gastroenterological Surgery, Adana City Training and Research Hospital, Adana, Turkey

⁴ MD, Specialist of General Surgery, Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey

⁵ MD, Specialist of Pathology, Department of Pathology, Adana City Training and Research Hospital, Adana, Turkey

⁶ MSc, MD, FEBS(hon), FACS, Department of Clinical Sciences, College of Medicine, Universty of Sharjah, Sharjah, United Arab Emirates

Abstract

Background: Xanthogranulomatous cholecystitis (XGC) is a rarely encountered chronic inflammatory condition presenting with severely proliferated fibrotic tissue. It usually spreads the neighboring organs, imitates gallbladder cancer, and may lead to difficulty in cholecystectomy.
Objectives: This study aimed to review the clinical and radiological findings, as well as surgical treatment results of XGC.
Methods: This retrospective study analyzed the clinical features of 36 cases with a diagnosis of XGC on pathology. The patients were operated on in our institute between 2012 and 2019.
Results: The rate of XGC in cholecystectomy patients was found to be 0.6 % (36/5999) in the hospital where this study was performed over seven years. The patients were aged 33-87 years, and the median age when the patients were diagnosed was 57 years. Moreover, the majority of the patients (52.8%; n=19) were male (male to female ratio: 1/1.11). The XGC was not accompanied by gallbladder carcinoma in any of these cases and could not be diagnosed in any of the patients prior to surgery. Radiological imaging performed before surgery demonstrated cholelithiasis, thickening of the gallbladder wall, and suspicious cancer in 29 (80.6%), 28 (77.8%), and 2 (5.6%) patients, respectively. However, none of the cases of XGC had concomitant gallbladder cancer. In total, 9 (25%) patients underwent open cholecystectomy, and 27 (75%) cases were scheduled to have laparoscopic cholecystectomy; however, 6 (16,8%) of these patients were converted to open cholecystectomy.
Conclusion: Laparoscopic cholecystectomy for XGC is possible; however, it is often difficult due to severe inflammation. Patients with XGC have a higher rate of conversion to open surgery and complications, compared to those with other forms of cholecystitis. The XGC may resemble gallbladder cancer based on the diagnostic imaging findings, and intraoperative frozen section analysis is essential to avoid unnecessarily extended surgery.

Keywords

• cholecystectomy
• English
• Cholecystitis
• gallbladder
• Xanthogranulomatous cholecystitis