A Rare Case of Xanthogranulomatous Cholecystitis: Diagnostic Challenges and Surgical Management

Abstract

Background: Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder characterised by destructive inflammation and xanthogranulomatous infiltration. Its clinical, radiological, and intraoperative resemblance to gallbladder carcinoma often creates significant diagnostic and surgical challenges. Case Presentation: A 63-year-old man with no significant medical history presented with a four-month history of right upper quadrant pain radiating to the right shoulder. Physical examination revealed right upper quadrant tenderness and a positive Murphy’s sign. Ultrasonography demonstrated a multilithiasic gallbladder with thin walls, while laboratory investigations were within normal limits. Laparoscopic exploration revealed a markedly thickened gallbladder with inflammatory changes suggestive of a more aggressive pathology. Cholecystectomy was successfully performed without complications. Histopathological examination confirmed xanthogranulomatous cholecystitis and excluded malignancy. Discussion: XGC predominantly affects older adults and is frequently associated with gallstones. Despite advances in imaging, distinguishing XGC from gallbladder carcinoma remains difficult due to overlapping clinical and radiological features. Intraoperative findings may appear suspicious for malignancy, potentially leading to extensive surgical procedures. Histopathological evaluation remains the gold standard for definitive diagnosis, while complete cholecystectomy is generally curative and associated with favourable outcomes. Conclusion: This case highlights the diagnostic complexity of XGC and the crucial role of histopathological examination in establishing an accurate diagnosis. Awareness of this uncommon entity is essential to avoid unnecessary radical surgery and to ensure appropriate surgical management.