Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution

P.B.S. Kansakar, G. Rodrigues, S.A. Khan

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 difficult. Objectives: To review the demographic and clinical aspects of xanthogranulomatous cholecystitis; to study the possibility of preoperative diagnosis and to identify the causes for difficult 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 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, 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 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.
Original languageEnglish
Pages (from-to)472-475
Number of pages4
JournalKathmandu University Medical Journal
Volume6
Issue number24
Publication statusPublished - 2008

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Tertiary Healthcare
Cholecystectomy
Health
Cholecystitis
Gallbladder
Laparoscopic Cholecystectomy
Cholecystostomy
Surgical Wound Infection
Calculi
Gallstones
Xanthogranulomatous cholecystitis
Abdomen
India
Ultrasonography
Urinary Bladder
Demography
Morbidity
Mortality
Neoplasms

Cite this

@article{b6e715eda90b493b9ceefc136ffb1f6d,
title = "Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution",
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 difficult. Objectives: To review the demographic and clinical aspects of xanthogranulomatous cholecystitis; to study the possibility of preoperative diagnosis and to identify the causes for difficult 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 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, 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 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.",
author = "P.B.S. Kansakar and G. Rodrigues and S.A. Khan",
note = "Cited By :4 Export Date: 10 November 2017 Correspondence Address: Rodrigues, G.; Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India; email: rodricksgaby@yahoo.co.in References: Rao, R.V., Kumar, A., Sikora, S.S., Saxena, R., Kapoor, V.K., Xanthogranulomatous cholecystitis: Differentiation from associated gall bladder carcinoma (2005) Trop Gastroenterol, 26, pp. 31-33; Kwon, A.-H., Matsui, Y., Uemura, Y., Surgical procedures and histopathologic findings for patients with xanthogranulomatous cholecystitis (2004) Journal of the American College of Surgeons, 199 (2), p. 347. , DOI 10.1016/j.jamcollsurg.2004.03.018, PII S1072751504003473; Goodman, Z.D., Ishak, K.G., Xanthogranulomatous cholecystitis (1981) American Journal of Surgical Pathology, 5 (7), pp. 653-659; Cardenas-Lailson, L.E., Torres-Gomez, B., Medina-Sanchez, S., Mijares-Garcia, J.M., Hernandez-Calleros, (2005) Cir Cir, 73, pp. 19-23; Guzman-Valdivia, G., Xanthogranulomatous cholecystitis in laparoscopic surgery (2005) Journal of Gastrointestinal Surgery, 9 (4), pp. 494-497. , DOI 10.1016/j.gassur.2004.09.036; Budhiraja, S., Wig, J.D., Gupta, N.M., Khanna, S.K., (2003) J Indian Med Assoc, 101, pp. 586-587; Guzman-Valdivia, G., Xanthogranulomatous Cholecystitis: 15 Years' Experience (2004) World Journal of Surgery, 28 (3), pp. 254-257. , DOI 10.1007/s00268-003-7161-y; Solanki, R.L., Arora, H.L., Gaur, S.K., Anand, V.K., Gupta, R., Xanthogranulomatous cholecystitis: Clinicopathological study of 21 cases (1989) Indian J Pathol Microbiol, 32, pp. 256-260; Singh, U.R., Argarwal, S., Misra, K., Histopathological study of xanthogranulomatous cholecystitis (1989) Indian Journal of Medical Research - Section B Biomedical Research Other Than Infectious Diseases, 90 (AUG), pp. 285-288; Houston, J.P., Collins, M.C., Cameron, I., Reed, M.W.R., Parsons, M.A., Roberts, K.M., Xanthogranulomatous cholecystitis (1994) British Journal of Surgery, 81 (7), pp. 1030-1032. , DOI 10.1002/bjs.1800810735; Khan, S., Rao, P., Rao, A., Rodrigues, G., Survey and evaluation of antibiotic prophylaxis usage in surgery wards of tertiary level institution before and after the implementation of clinical guidelines (2006) Indian Journal of Surgery, 68 (3), pp. 150-156",
year = "2008",
language = "English",
volume = "6",
pages = "472--475",
journal = "Kathmandu University Medical Journal",
issn = "1812-2027",
publisher = "Kathmandu University",
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}

Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution. / Kansakar, P.B.S.; Rodrigues, G.; Khan, S.A.

In: Kathmandu University Medical Journal, Vol. 6, No. 24, 2008, p. 472-475.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Xanthogranulomatous cholecystitis: A clinicopathological study from a tertiary care health institution

AU - Kansakar, P.B.S.

AU - Rodrigues, G.

AU - Khan, S.A.

N1 - Cited By :4 Export Date: 10 November 2017 Correspondence Address: Rodrigues, G.; Department of Surgery, Kasturba Medical College, Manipal, Karnataka, India; email: rodricksgaby@yahoo.co.in References: Rao, R.V., Kumar, A., Sikora, S.S., Saxena, R., Kapoor, V.K., Xanthogranulomatous cholecystitis: Differentiation from associated gall bladder carcinoma (2005) Trop Gastroenterol, 26, pp. 31-33; Kwon, A.-H., Matsui, Y., Uemura, Y., Surgical procedures and histopathologic findings for patients with xanthogranulomatous cholecystitis (2004) Journal of the American College of Surgeons, 199 (2), p. 347. , DOI 10.1016/j.jamcollsurg.2004.03.018, PII S1072751504003473; Goodman, Z.D., Ishak, K.G., Xanthogranulomatous cholecystitis (1981) American Journal of Surgical Pathology, 5 (7), pp. 653-659; Cardenas-Lailson, L.E., Torres-Gomez, B., Medina-Sanchez, S., Mijares-Garcia, J.M., Hernandez-Calleros, (2005) Cir Cir, 73, pp. 19-23; Guzman-Valdivia, G., Xanthogranulomatous cholecystitis in laparoscopic surgery (2005) Journal of Gastrointestinal Surgery, 9 (4), pp. 494-497. , DOI 10.1016/j.gassur.2004.09.036; Budhiraja, S., Wig, J.D., Gupta, N.M., Khanna, S.K., (2003) J Indian Med Assoc, 101, pp. 586-587; Guzman-Valdivia, G., Xanthogranulomatous Cholecystitis: 15 Years' Experience (2004) World Journal of Surgery, 28 (3), pp. 254-257. , DOI 10.1007/s00268-003-7161-y; Solanki, R.L., Arora, H.L., Gaur, S.K., Anand, V.K., Gupta, R., Xanthogranulomatous cholecystitis: Clinicopathological study of 21 cases (1989) Indian J Pathol Microbiol, 32, pp. 256-260; Singh, U.R., Argarwal, S., Misra, K., Histopathological study of xanthogranulomatous cholecystitis (1989) Indian Journal of Medical Research - Section B Biomedical Research Other Than Infectious Diseases, 90 (AUG), pp. 285-288; Houston, J.P., Collins, M.C., Cameron, I., Reed, M.W.R., Parsons, M.A., Roberts, K.M., Xanthogranulomatous cholecystitis (1994) British Journal of Surgery, 81 (7), pp. 1030-1032. , DOI 10.1002/bjs.1800810735; Khan, S., Rao, P., Rao, A., Rodrigues, G., Survey and evaluation of antibiotic prophylaxis usage in surgery wards of tertiary level institution before and after the implementation of clinical guidelines (2006) Indian Journal of Surgery, 68 (3), pp. 150-156

PY - 2008

Y1 - 2008

N2 - 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 difficult. Objectives: To review the demographic and clinical aspects of xanthogranulomatous cholecystitis; to study the possibility of preoperative diagnosis and to identify the causes for difficult 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 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, 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 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.

AB - 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 difficult. Objectives: To review the demographic and clinical aspects of xanthogranulomatous cholecystitis; to study the possibility of preoperative diagnosis and to identify the causes for difficult 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 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, 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 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.

M3 - Article

VL - 6

SP - 472

EP - 475

JO - Kathmandu University Medical Journal

JF - Kathmandu University Medical Journal

SN - 1812-2027

IS - 24

ER -