Ksantogranulomatozni holecistitis - dijagnostika i hirurško lečenje serije bolesnika

Abstract

Objective. Xanthogranulomatous cholecystitis (XGC) is a rare, benign variant of chronic gallbladder disease characterized by marked proliferative fibrosis and it causes significant difficulties in performing cholecystectomy. Methods. A total of 18 XGC cases were confirmed by retrospective analysis of the medical files of 562 patients undergoing cholecystectomy in our ward from January 2012 to May 2016. The median patients' age was 62 years (44-79) and the ratio of women to men was 2.6 : 1. Results. The clinical picture most often corresponds to chronic cholecystitis (61.1% of patients), and less frequently to acute cholecystitis (38.9%). Palpable mass below the right rib arch (33.3%) and jaundice (16.7%) was also observed. Gallbladder wall thickening, detected by ultrasound or computerized tomography scans, was observed in all patients. Gallbladder stones were present in 94.4% of patients. There were no confirmed cases of gallbladder cancer. All surgeries were technically difficult. The rate of laparoscopic conversion to open procedures was high (57.1%). The percentage of postoperative complications was also high (27.8%). There were no fatal outcomes in the analyzed series of patients. Conclusion. XGC creates difficulties during surgery, so any preoperative suspicion of XGC should prompt the surgeon to choose an open procedure as the main treatment choice. Rescue surgeries such as subtotal cholecystectomy should not be avoided. In the case of suspected gallbladder cancer intraoperative pathohistological examination is advised.