Management of Extensive Xanthogranulomatous Cholecystitis Lesions: A Case Report

BACKGROUND Xanthogranulomatous cholecystitis (XGC) is a rare benign gallbladder disease with an incidence rate ranging from 3.3% to 8.8%. XGC is prone to be misdiagnosed as gallbladder cancer when inflammatory lesions spread into the gallbladder wall and adjacent tissue. This case report explores the clinical and radiological features, surgical outcomes, and treatment strategies for extensive XGC lesions. CASE REPORT A 72-year-old woman had a 20-year history of intermittent recurrent abdominal pain and fever, which had worsened over the last 3 months. Physical examination revealed a 16×10 cm palpable mass in the right upper abdomen. Computed tomography (CT) showed inflammatory gallbladder dilation with diffuse wall thickening, and magnetic resonance imaging (MRI) showed diffuse gallbladder wall thickening with multiple cystic lesions and septate stones, and extensive inflammatory exudation spread around the duodenum, as well as the anterior peritoneum, measuring 107×76×96 mm, suggesting a diagnosis of XGC. Laparoscopic cholecystectomy was attempted but converted to open surgery due to dense adhesions, followed by hepatic wedge resection, common bile duct exploration with choledochotomy, and T-tube drainage. Postoperative histopathology confirmed XGC. No postoperative complications occurred, and the patient remained symptom-free over 7 years of follow-up. CONCLUSIONS Extensive XGC lesions pose significant management challenges. Laparoscopic cholecystectomy (LC) is preferred in cases with minimal adhesions and inflammation, while open surgery is recommended for complete lesion removal and to reduce complication risks in patients with dense adhesions.