Journal List > Korean J Gastroenterol > v.67(5) > 1007513

Chon and Kim: A Case of Xanthogranulomatous Inflammation of Terminal Ileum Presenting as a Mass in a Woman with Severe Obesity

Abstract

Xanthogranulomatous inflammation is an acute or chronic inflammatory condition most frequently reported in pyelonephritis and cholecystitis. However, the involvement of the terminal ileum is extremely rare. Its clinical significance is that it can mimic a malignant lesion clinically and intraoperatively, as well as radiographically. A 34-year-old European ethnic female presented with gradually aggravated abdominal pain in right lower quadrant for 15 days. There was no significant medical, surgical or traumatic history, except class III obesity (BMI, 41.0 kg/m2). An abdominal CT showed about a 4.7×3.7 cm sized, mass-like lesion in the terminal ileum. Despite symptomatic treatment, her clinical symptoms did not improve. After six days, she underwent a laparoscopic ileocecectomy. Pathologic findings showed extensive inflammation with occasional multinucleated giant cells and aggregates of foamy histiocytes, consistent with xanthogranulomatous inflammation. Here, we present a case of xanthogranulomatous inflammation in the terminal ileum presenting as subacute abdominal pain and a mass on imaging study. Xanthogranulomatous inflammation should be added to the differential diagnosis of patients with a suspected mass-like lesion in the terminal ileum.

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Fig. 1.
CT scan of abdomen. Seen is an approximately 4.7×3.7 cm sized, mass-like lesion (white arrow) in the terminal ileum.
kjg-67-277f1.tif
Fig. 2.
Intraoperative laparoscopic findings. (A) Inflammation and phlegmon with adhesions between the terminal ileum and abdominal wall.(B) Abscess pocket with pus discharges of the terminal ileum.
kjg-67-277f2.tif
Fig. 3.
Gross finding of resected ileocecal segment. It revealed mass-like thickening of the mesenteric fat with hemorrhage and adhesion at the terminal ileum. White arrow, terminal ileum; white arrowhead, mass-like lesion; black arrow, ileocecal valve; black arrowhead, cecum.
kjg-67-277f3.tif
Fig. 4.
Microscopic findings (H&E) of the resected specimen (A) showed extensive inflammation with occasional multinucleated giant cells and fibrosis (×100). (B) Higher magnification revealed aggregates of foamy histiocytes (×400).
kjg-67-277f4.tif
Table 1.
Review of Reported Cases of Small Bowel Involvement in Xanthogranulomatous Inflammation (XGI)
Reference Age (yr)/sex Underlying disease Location of small bowel XGI Other involved organ Clinical presentation Radiologic findings Treatment
Yoon et al.5 52/M None Terminal ileum None Abdominal pain CT: Appendiceal mass; bowel wall thickening of terminal ileum Laparoscopic right hemicolectomy
Wong et al.6 51/M HTN DM Gout Terminal ileum Appendix Abdominal pain US: 1.5 cm mass like lesion at ileocecal area
CT: None
Laparoscopic ileocecectomy
Bailey and Beck7 19/M None Ileum Sigmoid colon Abdominal pain Weight loss Flu-like symptoms CT: Abscess between small bowel and sigmoid colon Small bowel segmental resection and sigmoid colectomy
Present case 38/F Obesity Terminal ileum None Abdominal pain CT: About 4.7×3.7 cm sized, mass like lesion in terminal ileum Laparoscopic ileocecectomy

M, male; F, female; HTN, hypertension; DM, diabetes mellitus; US, ultrasonography.

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