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Xanthogranulomatous cholecystitis mimicking gallbladder cancer and causing obstructive cholestasis

Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 549-552页

作者： Paulo N Martins patricia sheiner Marcelo Facciuto Department of Surgery Transplant DivisionMassachusetts General HospitalHarvard Medical School Department of Surgery Division of Hepatobiliary Surgery and TransplantationNew York Medical College Division of Transplantation Mount Sinai Hospital

BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.

关键词： xanthogranulomatous cholecystitis gallbladder cancer obstructive cholestasis

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Clostridium paraputrificum septicemia and liver abscess

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World Journal of Hepatology 2018年第3期10卷 388-395页

作者： Yong K Kwon Faiqa A Cheema Bejon T Maneckshana Caroline Rochon patricia a sheiner Department of Transplant Hartford HospitalHartfordCT 06106United States

We report the first case of a healthy 23-year-old female who underwent an interventional radiology-guided embolization of a hepatic adenoma, which resulted in a gas forming hepatic liver abscess and septicemia by Clostridium paraputrificum. A retrospective review of Clostridial liver abscesses was performed using a Pub Med literature search, and we found 57 clostridial hepatic abscess cases. The two most commonly reported clostridial species are C. perfringens and C. septicum(64.9% and 17.5% respectively). C. perfringens cases carried a mortality of 67.6% with median survival of 11 h, and 70.2% of the C. perfringens cases experienced hemolysis. All C. septicum cases were found to have underlying liver malignancy at the time of the presentation with a mortality of only 30%. The remaining cases were caused by various Clostridium species, and this cohort's clinical course was significantly milder when compared to the above C. perfringens and C. septicum cohorts.

关键词： Clostridium Hemolysis Liver cell adenoma Morbidity Mortality Pyogenic liver abscess

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