Abstract
Introduction: Schistosomal cholecystitis is remarkably uncommon. Almost all of the reported cases in literature, less than eleven universally, are associated with concomitant gallstone disease. It is unclear whether the extensive fibrocalcific reaction of the bladders wall and the cystic duct, seen in all cases, predisposes to cholelithiasis, or gallstones coexist. Case report: We report a Greek patient who developed schistosomal granulomatous lithiasic cholecystitis, which is unique in Greek medical chronicles. Performing a safe cholecystectomy in this patient was extremely difficult due to badly inflamed gallbladder. Conclusion: Schistosoma infection is associated with chronic granulomatous inflammation making cholecystectomy difficult and unsafe. In this article, we focus especially on prevention of bile duct injury by being prepared that a patient with a possible schistosomal cholecystitis will present with a complicated case.
Highlights
Ultrasonographic abnormalities are prevalent in the gallbladder of patients with hepatosplenic schistosomiasis, including calcification and thickening of the wall with reduced fasting volume [8], a granulomatous cholecystitis with schistosomal egg deposition is an uncommon histopathological finding with few reports in the international literature
Evidence of a direct involvement of schistosoma on triggering an acute cholecystitis has been provided by Sharara et al these authors reported a case of alithiasic schistosomal cholecystitis in which no gallbladder abnormalities were ecographically demonstrable 10 days prior to the initiation of symptoms [18]
Apart from S. mansoni, S. haematobium may account for schistosomal cholecystitis [15]
Summary
Schistosomiasis is a parasitic disease caused by a trematode helminth of the schistosoma genus, acquired by contact with contaminated water [1]. Gastrointestinal manifestations, mainly caused by deposition of S. mansoni eggs in the gut wall, are the most common. We present a rare case of granulomatous cholecystitis associated with deposition of S. mansoni eggs in the gallbladder of a 77 years old male with concomitant cholelithiasis. On presentation to our department the patient reported a history of dull abdominal pain originating in the right upper quadrant together with repeated episodes of nausea and vomiting, lasting the past three months. Upper abdominal ultrasound was performed, showing a 1.7-cm gallstone impacted in the neck of a thick-walled (6.8 mm) gallbladder (Figure 1). After draining the content the impacted stone was extracted This approach allowed safe identification and ligation of the cystic duct and artery and the gallbladder was safely excised. After 6 months of follow-up the patient remains asymptomatic
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