A Case of Perforated Xanthogranulomatous Cholecystitis Presenting as Biloma

Yeon Jeong Ahn; Tae Hyo Kim; Sung Won Moon; Su Nyoung Choi; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee; Gyung Hyuck Ko

doi:10.4166/kjg.2011.58.3.153

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Ahn, Kim, Moon, Choi, Kim, Jung, Lee, and Ko: A Case of Perforated Xanthogranulomatous Cholecystitis Presenting as Biloma

Case Report

Korean J Gastroenterol 2011;58(3):153-156.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.3.153

A Case of Perforated Xanthogranulomatous Cholecystitis Presenting as Biloma

Yeon Jeong Ahn, Tae Hyo Kim, Sung Won Moon, Su Nyoung Choi, Hyun Jin Kim, Woon Tae Jung, Ok Jae Lee, Gyung Hyuck Ko¹

Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea

¹Department of Pathology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea

Correspondence to: Tae Hyo Kim, Department of Internal Medicine, Gyeongsang National University Hospital, 90, Chilam-dong, Jinju 660-702, Korea. Tel: +82-55-750-8726, Fax: +82-55-755-9078, E-mail: kimthy@medimail.co.kr

Received 4 January 2011 Accepted 12 May 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Perforated, Xanthogranulomatous cholecystitis, Laparoscopic cholecystectomy

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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.

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.

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).

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).

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