scholarly journals Xanthogranulomatous Cholecystitis: Our Clinical Experience

2021 ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Gallbladder Cancer ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Xanthogranulomatous Cholecystitis ◽  
Radiological Imaging ◽  
Fibrotic Tissue ◽  
Chronic Inflammatory Condition ◽  
Medical Examinations

Background: Xanthogranulomatous cholecystitis 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: The present study was directed towards reviewing the results of medical examinations and surgery for xan-thogranulomatous cholecystitis and providing proper surgical treatment for patients with xanthogranulomatous cholecystitis. Methods: This is an observational study in which clinical features of thirty six patients with diagnosis of cholecystitis who were operated in our institute between 2012 and 2019 and found as xanthogranulomatous cholecystitis on pathology were analyzed. Results: The rate of xanthogranulomatous cholecystitis in cholecystectomy patients was found to be 0.6 % (36/5999) in the hospital where this study was performed over 7 years. Xanthogranu-lomatous cholecystitis was not accompanied by gallbladder carcinoma in any of these cases. Xanthogranulomatous cholecystitis could not be diagnosed in any of the patients prior to surgery. Radiological imaging performed before surgery demonstrated cholelithiasis in 29 patients (80.6 %), thickening of the gallbladder wall in 28 patients (77.8%), and suspicious cancer in two patients (5.6%). However, none of the cases of xanthogranulomatous cholecystitis had concomitant gallbladder cancer. Nine (25%) patients underwent open cholecystectomy and Twenty seven patients (75 %) were scheduled to have laparoscopic cholecystectomy, but six of these patients (16,8%) were converted to open cholecystectomy. Conclusion: To conclude, it is still difficult to distinguish xanthogranulomatous cholecystitis from other gallbladder diseases both before and during surgery. The gallbladder commonly adheres to the neighboring organs and tissues and make surgical treatment difficult. A challenging laparoscopy is commonly converted to open surgery, which results in higher rates of complications as compared with standard open or laparoscopic cholecystectomy.

scholarly journals Cholelithiasis: causative factors, clinical manifestations and management

2019 ◽  
Vol 6 (6) ◽  
pp. 2133
Author(s):  
Renu Pimpale ◽  
Pradeep Katakwar ◽  
Murtaza Akhtar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Management ◽  
Open Cholecystectomy ◽  
Clinical Manifestations ◽  
Gastrointestinal Disorder ◽  
Xanthogranulomatous Cholecystitis ◽  
Biliary Leak ◽  
Common Complaint ◽  
Causative Factors ◽  
Operative Complications

Background: Cholelithiasis is a common gastrointestinal disorder with an overall prevalence of 2-29%. This study aims to evaluate the evolution of demographic and etiological factors, the clinical manifestations of Cholelithiasis, the surgical management with its post-operative complications and the histopathological findings of the post-cholecystectomy specimen of gallbladder, in central India.Methods: Patients symptomatic or asymptomatic diagnosed ultrasonically as cholelithiasis were included in the study and patients with primary choledocholithiasis were excluded.Results: A total of 92 patients were enrolled, of which 62 (68.89%) were female, with mean age of 45.03yrs ± 13.59. Fifty four patients (58.69%) were having BMI >25. Pain was most common complaint seen in all patients. Jaundice was observed in 13 patients (14.13%) who had associated CBD calculus. Sickling was positive in 8.69% of patients. Lap cholecystectomy was done in 71 (77.17%) patients with a conversion rate of 6.57%. Nineteen (20.65%) were open cholecystectomy with or without CBD exploration and 2 underwent Lap cholecystostomy. Post operatively, surgical site infection was seen in 3 patients (4.22%) of laparoscopic cholecystectomy, 5 patients (26.31%) of open cholecystectomy and biliary leak was seen in 3 patients (15.78%) of open cholecystectomy. Histopathology of gallbladder was chronic cholecystitis in 70 patients (77.77%), malignancy was detected in 5 patients (5.55%) and Xanthogranulomatous cholecystitis in 2 patients (2.22%).Conclusions: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Laparoscopic cholecystectomy offers best surgical management with lesser complications.

Significance of Preoperative Ultrasound Measurement of Gallbladder Wall Thickness

2007 ◽  
Vol 73 (9) ◽  
pp. 926-929 ◽  
Author(s):  
James Majeski
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Acalculous Cholecystitis ◽  
Gallbladder Wall ◽  
Chronic Cholecystitis ◽  
Entire Series ◽  
Calculous Cholecystitis ◽  
Gallbladder Ultrasound

Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic cholecystitis, which documents a thick gallbladder wall (≥3 mm) with calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure.

Unexpected gallbladder cancer as the source of some unknown primary cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16177-e16177
Author(s):  
Xiaowei Zhang ◽  
Xin Liu ◽  
Zhiguo Luo ◽  
Xichun Hu ◽  
Qifeng WANG ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallbladder Cancer ◽  
Clinical Data ◽  
Intraepithelial Neoplasia ◽  
Radical Resection ◽  
Gallbladder Wall ◽  
Recurrence Time ◽  
Unknown Primary ◽  
Cancer Type ◽  
First Line

e16177 Background: CUP (Cancer of Unknown Primary) represents a frequent cancer type causing incomparable difficulties in pathological diagnosis as compared to other tumor types. To explore and analyze the causes of CUP (Cancer of Unkown Primary) patients with misdiagnosis in patients after laparoscopic cholecystectomy with cholecystitis or cholecystolithiasis. Methods: 13 patients with CUP (Cancer of Unkown Primary) were recruited in this research, who accepted the multidisciplinary discussion of the CMUP (Cancer of Multiple or Unknown Primary) multidisciplinary team. Our team analyzed the clinical data and pathological characteristics of these patients, and tried to find the common characteristics of the CUP patients whose primary site is the gallbladder that has been already removed. Results: 13 patients were received laparoscopic cholecystectomy because of previously considered cholecystitis or cholecystolithiasis. The gallbladder is considered as the primary organ supported by the pathological features of the metastatic sites. Importantly, all these patients have local abdominal wall and/or local perigallbladder lymph node metastases. Among them, 3 cases were diagnosed as gallbladder cancer, and 1 case was considered as high-grade intraepithelial neoplasia after pathological consultation, which were recognized as benign disease. Among the 13 cases, 9 cases showed local thickening of the gallbladder wall by preoperative CT or B-ultrasound. The median recurrence time was 16.4 months (9-48 months). Of the 13 patients, 5 received radical resection again, and received GP (gemcitabine plus platinum) chemotherapy after surgery. Of the 8 patients who were unable to undergo radical surgery, 5 received first-line GP based chemotherapy, 2 received first-line PD-1 immunotherapy combined with anti-vascular targeted drugs, and 1 received tegafur monotherapy due to poor physical condition. Till now, these patients are still under follow-up. Conclusions: Unexpected gallbladder cancer is the source of some unknown primary cancers. For these patients with cholecystitis or cholecystolithiasis, B-ultrasound examination should not be performed alone, and CT or MRI examination should be performed when necessary. We should pay high attention to the patients with cholecystitis or gallstone thickening of the gallbladder wall or other high-risk gallbladder cancer. Before surgery, clinical data should be analyzed comprehensively, and rapid frozen examination should be performed on patients suspected of having cancer. In order to avoid misdiagnosis, we should pay attention to the principle of none tumor and avoid the risk of incision implantation. If unexpected gallbladder cancer is found, radical operation should be performed as soon as possible.

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

1970 ◽  
Vol 6 (4) ◽  
pp. 472-475 ◽  
Author(s):  
PBS Kansakar ◽  
G Rodrigues ◽  
SA Khan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conversion Rate ◽  
Preoperative Diagnosis ◽  
Open Cholecystectomy ◽  
Bladder Wall ◽  
Tertiary Care ◽  
Chronic Cholecystitis ◽  
Clinical Aspects ◽  
Wall Thickening ◽  
Xanthogranulomatous Cholecystitis

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. Key words: Xanthogranulomatous cholecystitis, Cholecystectomy, Malignancy doi: 10.3126/kumj.v6i4.1738   Kathmandu University Medical Journal (2008), Vol. 6, No. 4, Issue 24, 472-475

scholarly journals Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively?

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ashwin Rammohan ◽  
Sathya D. Cherukuri ◽  
Jeswanth Sathyanesan ◽  
Ravichandran Palaniappan ◽  
Manoharan Govindan
Keyword(s):  
Gallbladder Cancer ◽  
Preoperative Diagnosis ◽  
Histopathological Examination ◽  
Radical Resection ◽  
Gallbladder Wall ◽  
Wall Thickening ◽  
Xanthogranulomatous Cholecystitis ◽  
Radiological Features ◽  
Group A ◽  
Group B

Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC.Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC.Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases.Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases.

Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy

2020 ◽  
Vol 61 (11) ◽  
pp. 1452-1462
Author(s):  
Young Rock Jang ◽  
Su Joa Ahn ◽  
Seung Joon Choi ◽  
Ki Hyun Lee ◽  
Yeon Ho Park ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Prothrombin Time ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Acute Calculous Cholecystitis ◽  
Prolonged Prothrombin Time ◽  
Ct Findings ◽  
History Of ◽  
Calculous Cholecystitis

Background Previous studies evaluating predictive factors for the conversion from laparoscopic to open cholecystectomy have reported conflicting conclusions. Purpose To create a risk assessment model to predict the conversion from laparoscopic to open cholecystectomy in patients with acute calculous cholecystitis. Material and Methods A retrospective review of patients with acute calculous cholecystitis with available preoperative contrast-enhanced computed tomography (CT) findings who underwent laparoscopic cholecystectomy was performed. Forty-four parameters—including demographics, clinical history, laboratory data, and CT findings—were analyzed. Results Among the included 581 patients, conversion occurred in 113 (19%) cases. Multivariate analysis identified obesity (odd ratio [OR] 2.58, P = 0.04), history of abdominal surgery (OR 1.78, P = 0.03), and prolonged prothrombin time (OR 1.98, P = 0.03) as predictors of conversion. In preoperative CT findings, the absence of gallbladder wall enhancement (OR 3.15, P = 0.03), presence of a gallstone in the gallbladder infundibulum (OR 2.11, P = 0.04), and inflammation of the hepatic pedicle (OR 1.71, P = 0.04) were associated with conversion. Inter-observer agreement for CT study interpretation was very good (range 0.81–1.00). A model was created to calculate the risk for conversion, with an area under the receiver operating characteristic curve of 0.87. The risk for conversion, estimated based on the number of factors identified, was in the range of 5.3% (with one factor) to 86.4% (with six factors). Conclusion Obesity, history of abdominal surgery, prolonged prothrombin time, absence of gallbladder wall enhancement, presence of a gallstone in the gallbladder infundibulum, and inflammation of the hepatic pedicle are associated with conversion of laparoscopic to open cholecystectomy.

Surgical Treatment of Incidental Gallbladder Cancer Discovered During or Following Laparoscopic Cholecystectomy

2014 ◽  
Vol 39 (3) ◽  
pp. 746-752 ◽  
Author(s):  
Yuan-Hu Tian ◽  
Xu Ji ◽  
Bo Liu ◽  
Guang-Yun Yang ◽  
Xiang-Fei Meng ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Gallbladder Cancer ◽  
Incidental Gallbladder Cancer

scholarly journals Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3354
Author(s):  
Mohanapriya Thyagarajan ◽  
Balaji Singh ◽  
Arulappan Thangasamy ◽  
Shobana Rajasekar
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Related Factors ◽  
Previous Episode ◽  
Factors Influencing

Background: Gall stone disease is a common disease affecting human beings. Over the past two decades, laparoscopic cholecystectomy has become gold standard for the surgical treatment of gallbladder disease. The advantages of laparoscopic cholecystectomy over open surgery are a shorter hospital stay, less postoperative pain, faster recovery, better cosmoses. This study was planned to identify the circumstances and the risk factors influencing the conversion of laparoscopic cholecystectomy to open procedure.Methods: This is a Prospective study conducted over a period of 24 months. A total of 50/500 patients who were electively posted for laparoscopic cholecystectomy and got converted into open cholecyctectomy were included in the study. The Factors recorded and analysed were Age and Sex of the patient, presence of diabetes mellitus, previous episode of Acute Cholecystitis, Body Mass Index, presence of abdominal scar, total count, Ultrasonagram Abdomen findings of Gallbladder wall thickness and presence of pericholecystic fluid.Results: In our study, it has been observed that Patient Related Factors - Age >50yrs, Male gender, Presence of Diabetes Mellitus, Obesity, previous Abdominal surgeries and Disease Related Factors - previous episode of Acute Cholecystitis, presence of Acute Cholecystitis, Gallbladder wall thickness >4mm, presence of Pericholecystic fluid were found to be significant risk factors in conversion of laparoscopic to open cholecystectomy.Conclusions: These risk factors help to predict the difficulty of the procedure and this would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.

scholarly journals Utility of pre-operative abdominal ultrasound to predict conversion to open cholecystectomy

2021 ◽  
Vol 8 (10) ◽  
pp. 3007
Author(s):  
Reetesh Sharma ◽  
Ramesh Dumbre ◽  
Arun Fernandese ◽  
Deepak Phalgune
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Fluid Collection ◽  
Biliary Tree ◽  
Gallbladder Wall ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

Background: Many factors like unclear Calot triangle anatomy, intensely inflamed and thick gallbladder, dense adhesions in the operative area, obscure biliary tree anatomy, local inflammation like pancreatitis contribute to the conversion of laparoscopic cholecystectomy to open cholecystectomy. The aim of the present study was to find the utility of abdomen sonography parameters that predict the conversion from laparoscopic to open cholecystectomy.Methods: Ninety patients aged between 20 and 75 years with the diagnosis of cholelithiasis/cholecystitis were included in this observational study. Every patient underwent ultrasonography (USG). The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, size of the calculi, presence of abdominal adhesions, size of the common bile duct was recorded. If feasible, laparoscopic cholecystectomy was done. If not, the procedure was converted to open cholecystectomy. Association of USG findings was correlated with conversion to open cholecystectomy. The comparison of the qualitative variables was done using Fisher’s exact test. Results: Of 90 patients, 7 (7.8%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.Conclusions: Pre-operative USG parameters did not predict conversion to open cholecystectomy.

scholarly journals Perfidious Gallbladders – A Diagnostic Dilemma with Xanthogranulomatous Cholecystitis

2007 ◽  
Vol 89 (2) ◽  
pp. 168-172 ◽  
Author(s):  
Gandrapu NS Srinivas ◽  
Surajit Sinha ◽  
Nick Ryley ◽  
Paul WJ Houghton
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallbladder Carcinoma ◽  
Conversion Rate ◽  
Average Length ◽  
Care Pathway ◽  
Bile Leak ◽  
Common Bile Duct Stones ◽  
Gallbladder Wall ◽  
Xanthogranulomatous Cholecystitis ◽  
Diagnostic Dilemma

INTRODUCTION Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis characterised by marked thickening of the gallbladder wall and dense local adhesions. Pre-operative and intra-operative diagnosis is difficult and it often mimics a gallbladder carcinoma (GBC). Laparoscopic cholecystectomy (LC) is frequently unsuccessful with a high conversion rate. A series of patients with this condition led us to review our experience with XGC and to try to develop a care pathway for its management. PATIENTS AND METHODS A retrospective review of the medical records of 1296 consecutive patients who had undergone cholecystectomy between January 2000 and April 2005 at our hospital was performed. Twenty-nine cases of XGC were identified among these cholecystectomies. The clinical, radiological and operative details of these patients have been analysed. RESULTS The incidence of XGC was 2.2% in our study. The mean age at presentation was 60.3 years with a female:male ratio of 1.4:1. Twenty-three patients (79%) required an emergency surgical admission at first presentation. In three patients, a GBC was suspected both radiologically and at operation (10.3%), but was later disproved on histology. Seventeen patients (59%) had obstructive jaundice at first presentation and required an endoscopic retrograde cholangiopancreatography (ERCP) before LC. Of these, five had common bile duct stones. Abdominal ultrasound scan showed marked thickening of the gallbladder wall in 16 cases (55%). LC was attempted in 24 patients, but required conversion to an open procedure in 11 patients (46% conversion rate). A total cholecystectomy was possible in 18 patients and a partial cholecystectomy was the choice in 11 (38%). The average operative time was 96 min. Three patients developed a postoperative bile leak, one of whom required ERCP and placement of a biliary stent. The average length of stay in the hospital was 6.3 days. CONCLUSIONS Severe xanthogranulomatous cholecystitis often mimics a gallbladder carcinoma. Currently, a correct pre-operative diagnosis is rarely made. With increased awareness and a high index of suspicion, radiological diagnosis is possible. Preoperative counselling of these patients should include possible intra-operative difficulties and the differential diagnosis of gallbladder cancer. Laparoscopic cholecystectomy is frequently unsuccessful and a partial cholecystectomy is often the procedure of choice.

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