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Jacklyn M So-Cabahug
Manila Doctors Hospital, Philippines
Posters & Accepted Abstracts: J Hepato Gastroenterol
Xanthogranulomatous cholecystitis is an uncommon form of cholecystitis often being misdiagnosed as gallbladder carcinoma, hence poses as a diagnostic challenge for physicians. The proposed mechanism of the formation of this lesion is through mucosal ulceration or the rupture of Rokitansky-Aschoff sinuses due to increased intraluminal pressure. This causes granulomatous changes that lead to the formation of intramural nodules. Due to its nature of presenting as a gallbladder mass, certain surgical interventions can become unwarranted, which may diminish the patient’s quality of life. This paper presents a case of a 59-yearold male who presented with epigastric pain, initially treated as reflux disease, relieved by antacids, antispasmodics and opioid analgesics. The imaging studies revealed a mass in the gallbladder with signs of cholecystitis. The patient underwent intraoperative ultrasound, extended cholecystectomy and lymph node dissection with an unremarkable postoperative course. The final histopathology revealed chronic xanthogranulomatous cholecystitis and was negative for malignancy. This paper further reviews the presentation of the lesion under different imaging modalities. On ultrasound, it appears as a hypoechoic focus and marked or focal thickening of the gallbladder wall, while on computed tomography, it presents with hypoattenuating nodules in thickened walls, luminal surface enhancement with continuous mucosal lines. However, on magnetic resonance imaging, it may appear as either a reduced signal intensity on out of phase images or slightly high signal intensity and slight enhancement on early phase and strong enhancement on the late phase. In general, the recommended treatment approach is through open cholecystectomy.
Jacklyn M. So-Cabahug is currently a fellow in the training of Gastroenterology at Manila Doctors Hospital in the Philippines. She received her undergraduate degree in Public Health from the University of the Philippines and her MD from the University of Santo Tomas. She completed her residency in internal medicine at Medical Center Manila. During this time, she dove head first in the field of research, getting both her papers published in the Philippine Journal of Internal Medicine. Dr. So-Cabahug started educating young students early in her career. She believes that encouraging the next generation of physicians to take an interest in research, paves the way for innovations with the endpoint of improving patient outcomes.
