Korean J Gastroenterol.  2011 Sep;58(3):153-156. 10.4166/kjg.2011.58.3.153.

A Case of Perforated Xanthogranulomatous Cholecystitis Presenting as Biloma

• Ahn YJ
• Kim TH
• Moon SW
• Choi SN
• Kim HJ
• Jung WT
• Lee OJ
• Ko GH

• KMID: 1018404
• DOI: http://doi.org/10.4166/kjg.2011.58.3.153

Abstract

Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.

Keyword

Perforated; Xanthogranulomatous cholecystitis; Laparoscopic cholecystectomy

MeSH Terms

Aged, 80 and over
Bilirubin/blood
Cholecystectomy
Cholecystitis/*diagnosis/pathology/ultrasonography
Drainage
Female
Gallbladder Neoplasms/diagnosis
Granuloma/*diagnosis/pathology/ultrasonography
Humans
Tomography, X-Ray Computed
Xanthomatosis/*diagnosis/pathology/ultrasonography

Figure

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  Fig. 1. CT scan of abdomen. It showed a focal gallbladder wall thickening and fluid collection in the subhepatic space. There was no definitive connection between the fluid collection and the gallbladder.

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  Fig. 2. Follow-up CT scan of abdomen. It showed that the cystic mass increased in size (11×5 cm) with wall enhancement in the subhepatic space.

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  Fig. 3. Gross findings of the specimen. The gallbladder was characterized by a thickened wall with poorly circumscribed yellowish granular necrotic areas and perforation (arrow).

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  Fig. 4. Microscopic findings of the specimen. (A) The ulcerated mucosa of the gallbladder was stained with bile pigments (H&E stain, ×40). (B) The subepithelial connective tissue of the gallbladder showed a massive aggregation of foamy macrophages. There were also infiltration of lymphocytes, plasma cells and occasional multinucleated giant cells. Many macrophages contained both ceroid pigments and cholesterol (H&E stain, ×400).

Reference

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