Xanthogranulomatous Cholecystitis : Rare Form of Cholecystitis, Single Center Experience

Öz

Xanthogranulomatous cholecystitis (XGC) is a rare form of cholecystitis characterized by extensive fibrosis. Although laparoscopic cholecystectomy (LC) is difficult due to its confusion with malignancy and adhesion to the surrounding tissues, it is the gold standard treatment method. Within the scope of the current study, it was aimed to evaluate the results of patients who underwent cholecystectomy with the diagnosis of XGC by a single center. 96 patients who underwent cholecystectomy for XGC between 2008 and 2022 by a single center were included in the study. Demographic data of the patients, preoperative diagnosis, imaging findings, biliary drainage requirement, acute pancreatitis findings (with radiological+biochemical), intraoperative findings, rates of conversion to open surgery, postoperative complications, and length of hospital stay were retrospectively analyzed. Of the patients, 68 (70.8%) were male and 28 (29.2%) were female. The mean age of the patients was 60.4 ± 13.3 (22-86). The most common reason for admission was abdominal pain (65.6%). Percutaneous and/or endoscopic biliary drainage methods were applied to 24 (25%) patients in the preoperative period. All patients were operated with the laparoscopic technique, and open cholecystectomy was performed in 59 (61.4%) of them. While the mean hospital stay of the patients was 8.75 ± 7.1, 1 (1%) patient had postoperative pneumonia and mortality after sepsis. XGC is important because it can be confused with malignancy radiologically, clinically and surgically. Frozen evaluation should be performed in suspicious cases. Although high conversion rates are known, laparoscopic cholecystectomy is still known as the gold standard treatment method.

Anahtar Kelimeler

• Xanthogranulomatous Cholecystitis
• Laparoscopic Cholecystectomy
• Surgical Treatment

Ksantogranülomatöz Kolesistit: Nadir Kolesistit Formu, Tek Merkez Deneyimi

Öz

Ksantogranülomatöz Kolesistit (KGK), yaygın fibrozis ile karakterize nadir görülen bir kolesistit formudur. Malignite ile karışabilme ve çevre dokulara yapışıklık nedeniyle laparoskopik kolesistektomi (LK) zor olsa da, altın stardart tedavi şeklini oluşturmaktadır. Mevcut çalışma kapsamında, tek merkez tarafından KGK tanısı ile kolesistektomi yapılan hastaların sonuçlarının değerlendirilmesi amaçlanmıştır. 2008-2022 yılları arasında tek merkez tarafından KGK nedeniyle kolesistektomi yapılan 96 hasta çalışmaya dahil edildi. Hastaların demografik verileri, preoperatif tanı, görüntüleme bulguları, bilier drenaj gereksinimi ve yöntemleri, akut pankreatit bulguları (radyoloji + biyokimyasal yöntemler ile), intraoperatif bulgular, açık ameliyata geçme oranları (konversiyon), ameliyat sonrası gelişen komplikasyonlar ve hastanede kalış süresi retrospektif olarak incelendi. Hastaların 68 (%70,8) erkek, 28 (%29,2) kadın idi. Hastaların ortalama yaşı 60.4 ± 13.3 (22-86) idi. En sık başvuru nedeni karın ağrısıydı (%65,6). Preoperatif dönemde 24 (%25) hastaya perkütan ve/veya endoskopik bilier drenaj yöntemleri uygulandı. Hastaların tamamına laparoskopik teknikle ameliyata başlanmış olup, 59 (%61,4) unda açık kolesistektomiye geçilmiştir. Hastaların ortalama yatış süresi 8,75 ± 7,1 olurken, 1 (%1) hastada postoperatif dönemde gelişen pnömoni ve buna bağlı sepsis sonrası mortalite gözlenmiştir. KGK, radyolojik, klinik ve cerrahi olarak malignite ile karışabilmesi bakımından önemlidir. Şüpheli vakalarda frozen değerlendirme yapılmalıdır. Yüksek konversiyon oranları bilinse de laparoskopik kolesistektomi halen altın standart tedavi yöntemi olarak bilinmektedir.

Anahtar Kelimeler

• Ksantogranülomatöz Kolesistit
• Laparoskopik Kolesistektomi
• Cerrahi Tedavi
• Xanthogranulomatous Cholecystitis
• Laparoscopic Cholecystectomy
• Surgical Treatment

Kaynakça

1. 1.Christensen AH, Ishak KG. Benign tumors and pseudotumors of the gallbladder. Report of 180 cases. Arch Pathol 1970;90:423-32.
2. 2.Yang T, Zhang BH, Zhang J, Zhang YJ, Jiang XQ, Wu MC.Surgical treatment of xanthogranulomatous cholecystitis: experience in 33 cases. Hepatobiliary Pancreat Dis Int 2007;6:504-8.
3. 3.Levy AD, Murakata LA, Abbott RM, Rohrmann CA Jr. Fromthe archives of the AFIP. Benign tumors and tumorlike lesionsof the gallbladder and extrahepatic bile ducts: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics 2002;22:387-413.
4. 4.Guzman-Valdivia G. Xanthogranulomatous cholecystitis: 15 years' experience. World J Surg 2004;28:254-7.
5. 5.Fligiel S, Lewin KJ. Xanthogranulomatous cholecystitis: case report and review of the literature. Arch Pathol Lab Med1982;106:302-4.
6. 6.Park JW, Kim KH, Kim SJ, Lee SK. Xanthogranulomatous cholecystitis: is an initial laparoscopic approach feasible? Surg Endosc 2017;31:5289-94.
7. 7.Reano G, Sanchez J, Ruiz E, et al. Xanthogranulomatous cholecystitis: retrospective analysis of 6 cases. Rev Gastroenterol Peru 2005;25:93-100.
8. 8.Strom BL, Maislin G, West SL, Atkinson B, Herlyn M, Saul S,et al. Serum CEA and CA 19-9: potential future diagnostic or screening tests for gallbladder cancer? Int J Cancer1990;45:821-4.

9. 9.Qasaimeh GR, Matalqah I, Bakkar S, Al Omari A, Qasai- meh M. Xanthogranulomatous cholecystitis in the laparo- scopic era is still a challenging disease. J Gastrointest Surg 2015;19:1036–1042.
10. 10.Park JW, Kim KH, Kim SJ, Lee SK. Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible? SurgEndosc 2017;31:5289–5294.
11. 11.Hale MD, Roberts KJ, Hodson J, Scott N, Sheridan M,Toogood GJ. Xanthogranulomatous cholecystitis: A Euro- peanand global perspective. HPB (Oxford) 2014;16:448– 458.
12. 12.Zhuang PY, Zhu MJ, Wang JD, Zhou XP, Quan ZW, Shen J. Xanthogranulomatous cholecystitis: A clinicopathologi- cal study of its association with gallbladder carcinoma. J Dig Dis 2013;14:45–50.
13. 13.Kwon A-H, Matsui Y, Uemura Y. Surgical procedures and histopathologic findings for patients with xantho- granulomatous cholecystitis. J Am Coll Surg 2004;199: 204–210.
14. 14.WangM,ZhangT,ZangL,LuA,MaoZ,LiJ,DongF,Hu W, Jiang Y, Zheng M. Surgical treatment for xanthogranulomatous cholecystitis: A report of 74 cases. Surg Laparosc Endosc Percutan Tech 2009;19:231–233.
15. 15.Yabanoglu H, Aydogan C, Karakayalı F, Moray G, Haberal M.Diagnosis and treatment of xanthogranulomatous chole- cystitis. Eur Rev Med Pharmacol Sci 2014;18:1170–1175.
16. 16.Suzuki H, Wada S, Araki K, Kubo N, Watanabe A, Tsu- kagoshi M, Kuwano H. Xanthogranulomatous cholecysti- tis: Difficulty in differentiating from gallbladder cancer. World J Gastroenterol 2015;21:10166–10173.
17. 17.Benbow EW. Xanthogranulomatous cholecystitis associ- ated with carcinoma of the gallbladder. Postgrad Med J 1989;65:528–531.