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Chirurgie 22. Dezember 2014

Xanthogranulomatous cholecystitis: an analysis of 55 cases

Background/objective: Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder characterized by a focal or diffuse destructive inflammatory process. The aim of this study was to identify the common clinical and surgical characteristics of XGC patients.

Methods: The records of all cases of XGC histopathologically diagnosed between January 2009 and March 2014 at the Antalya Training and Research Hospital, Antalya, were analyzed retrospectively for collection of data regarding clinical and histopathological characteristics, imaging and surgical findings, comorbidities, nature and duration of surgery, additional procedures performed, and postoperative complications.

Results: The incidence of pathologically diagnosed XGC among the 5765 patients who had undergone cholecystectomy during the study period was 0.95 % (55 patients). The incidence of elevated liver enzymes and elevated bilirubin levels was 25.5 % (14 patients) and 14.5 % (8 patients), respectively. Laparoscopic cholecystectomy could be performed for 45.5 % of cases (25 patients), while the remaining 54.5 % cases (30 patients) required open cholecystectomy. All cases were pathologically characterized by a focal or diffuse destructive inflammatory process that produced varying proportions of lipid-laden macrophages, inflammatory cells, and fibroblasts and by the presence of foam cells and xanthomatous changes. The incidence of postoperative wound infection and wound gaping was 18.2 % (10 patients) and 1.8 % (1 patient), respectively.

Conclusion: Although XGC is a rare condition with a low mortality rate, its treatment is associated with a relatively high incidence of postoperative wound infections and other complications, a fact that should be considered when deciding on the ideal surgical option.

M. N. Kosar, A. Ongen, B. R. Karakas, M. Habibi, G. Cantilav, Assoc. Prof. N. Bulbuller, European Surgery 6/2014

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