A Rare Pathology of Difficult Laparoscopic Cholecystectomy: Xanthogranulomatous Cholecystitis.

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory condition of the gallbladder (GB). Preoperatively, it is a diagnostic challenge. One thousand and seventy nine laparoscopic cholecystectomy (LC) patients from September 2012 to June 2015 were retrospectively reviewed. Fourteen patients were identified with XGC. An analysis was carried out on this group of patients looking at postoperative pathology results, preoperative radiology, operative findings and outcome. The overall frequency of XGC was 1.3%. A thick walled GB was found in 11 patients on preoperative imaging. Retrospectively suggestive feature thick gallbladder walls with low attenuation mural nodules. No suspicion of cancer was demonstrated in the final histology or preoperatively. Five cases (36%) perforated intraoperatively. Although all were surgically challenging, no conversions to open were performed. The perforation risk could be higher. A difficult cholecystectomy should alert a surgeon to consider XGC as a diagnosis. Contrary to the popular belief, XGC was found to be difficult to differentiate from infection rather than malignancy.

Actinomycosis of the sigmoid colon: A case report.

Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species. The ileo-cecal region is most commonly affected, while the left side of the colon is more rarely involved. The infection has a tendency to infiltrate adjacent tissues and is therefore rarely confined to a single organ. Presentation may vary from non specific symptoms and signs to an acute abdomen. A computed tomography scan is helpful in identifying the inflammatory process and the organs involved. It also allows visual guidance for percutaneous drainage of abscesses, thus aiding diagnosis. Culture is difficult because of the anaerobic character and slow growth of actinomycetes. Colonoscopy is usually normal, but may shows signs of external compression. Preoperative diagnosis is rare and is established only in less than 10% of cases. In uncomplicated disease, high dose antibiotic therapy is the mainstay of treatment. Surgery is often performed because of a difficulty in diagnosis. Surgery and antibiotics are required in the case of complicated disease. Combined medical and surgical treatment achieves a cure in about 90% of cases. The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology, and a review of the literature is presented.