Mao Derek, Mekaeil Bishoy, Lyon Matthew, Kandpal Harsh, Pynadath Joseph Varghese, Gupta Shilpi, Chandrasegaram Manju Dashini
Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia.
Department of General Surgery, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia.
Int J Surg Case Rep. 2021 Jan;78:223-227. doi: 10.1016/j.ijscr.2020.12.035. Epub 2020 Dec 16.
Acute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome (MS) is a complex surgical problem both diagnostically and in terms of management as it mimics both xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma.
A 48-year-old gentleman was referred to us with biliary colic and weight loss with ultrasound findings of gallstones. At subsequent follow-up he became deeply jaundiced with deranged liver function and a CT showing a gallbladder mass and dilated biliary tree. Follow-up MRCP suggested XGC and concomitant MS, but a malignant process could not be excluded. Pre-operative fine needle aspiration cytology (FNAC) at the time of percutaneous biliary drainage for his jaundice demonstrated XGC with no evidence of malignancy. Given the dense inflammation and a tense empyema at laparoscopy, he underwent a subtotal fenestrating cholecystectomy. The final histopathological diagnosis was acute cholecystitis.
Our patient likely had unrecognised acute cholecystitis which progressed to a complex mass with empyema and type I Mirizzi Syndrome, ultimately resulting in severe obstructive jaundice mimicking gallbladder carcinoma. Given that a laparoscopic total cholecystectomy is dangerous in these cases of severe inflammation, a laparoscopic subtotal cholecystectomy has been shown to be a safe alternative to more invasive strategies and was successfully utilised in our patient.
Acute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome is a rare manifestation that requires adequate pre-operative work-up to exclude malignancy. Subtotal fenestrating cholecystectomy is a safe and effective alternative to open surgery in these cases of complex inflammation.
急性重症胆囊炎合并积脓表现为胆囊肿块、黄疸和Mirizzi综合征（MS），是一个复杂的外科问题，在诊断和治疗方面都很棘手，因为它既类似黄色肉芽肿性胆囊炎（XGC），又类似胆囊癌。
一名48岁男性因胆绞痛和体重减轻前来就诊，超声检查发现有胆结石。在随后的随访中，他出现了深度黄疸，肝功能紊乱，CT显示有胆囊肿块和胆管扩张。后续的磁共振胰胆管造影（MRCP）提示为XGC并伴有MS，但不能排除恶性病变。在为其黄疸进行经皮胆道引流时，术前细针穿刺抽吸细胞学检查（FNAC）显示为XGC，无恶性证据。鉴于腹腔镜检查时炎症严重且积脓张力高，他接受了开窗式胆囊次全切除术。最终的组织病理学诊断为急性胆囊炎。
我们的患者可能最初患有未被识别的急性胆囊炎，进而发展为伴有积脓和I型Mirizzi综合征的复杂肿块，最终导致类似胆囊癌的严重梗阻性黄疸。鉴于在这些严重炎症病例中进行腹腔镜胆囊全切除术很危险，开窗式胆囊次全切除术已被证明是一种比更具侵入性的手术策略更安全的替代方法，并成功应用于我们的患者。
急性重症胆囊炎合并积脓表现为胆囊肿块、黄疸和Mirizzi综合征是一种罕见的表现，需要进行充分的术前检查以排除恶性病变。在这些复杂炎症病例中，开窗式胆囊次全切除术是开放手术的一种安全有效的替代方法。
