Thick-walled Gallbladder: A Pragmatic Management Approach.

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Thick-walled gallbladder (TWGB) is a common yet non-specific radiological finding associated with a wide range of gallbladder pathologies, including acute and chronic inflammation, infection, and malignancy. Among the inflammatory causes, xanthogranulomatous cholecystitis (XGC) is a rare but significant condition that often mimics gallbladder carcinoma. This paper presents a pragmatic approach to the diagnosis and management of TWGB, focusing on the complexities posed by XGC. Detailed analysis of imaging techniques, surgical strategies, and histopathological findings is provided to guide clinical decision-making. This paper presents a pragmatic approach to the diagnosis and management of TWGB, with a particular focus on the complexities posed by XGC mimicking a gallbladder mass in operated patients of TWGB in a tertiary care center over 2 years. Detailed analysis of imaging techniques, surgical strategies, and histopathological findings is provided to guide clinical decision-making. We had 18 patients of TWGB, 14 males (77.7%) and 4 females (22.2%) who were a part of the prospective study. All cases underwent anticipatory extended cholecystectomy (AEC) with frozen section assessment during the period of 2 years. All these cases were evaluated with ultrasound, triple-phase CT followed by MR/MRCP, and CA 19-9 levels as outlined in the flowchart. In this study out of 18 patients who underwent AEC the frozen section of 15 cases of patients was reported as XGC, and 3 cases were reported as carcinoma GB with T1b stage and these 3 cases further underwent EC in the same setting. Out of 18 cases, 16 had an uneventful postop period and 2 cases developed complications Bile leak which was managed by pigtail drainage and bleeding managed by blood transfusions (Clavien-Dindo Classification-Grade III). All TWGB are not carcinoma GB. Xanthogranulomatous cholecystitis is an important differential diagnosis for TWGB and, therefore, XGC should be considered in the differential diagnosis of TWGB. Ganaie IA, Manzoor S, Qadri AI, et al. Thick-walled Gallbladder: A Pragmatic Management Approach. Euroasian J Hepato-Gastroenterol 2024;14(2):191-197.