DOI: 10.36347/sjmcr.2023.v11i04.080

Pages: 738-741

Introduction: Xanthogranulomatous cholecystitis is a rare condition with a specific symptoms. The main differential diagnosis is vesicular adenocarcinoma. It can be revealed by abdominal pain, hemorrhage or fistulas. We report here the case of a patient with xanthogranulomatous cholecystitis revealed by febrile abdominal pain. We report a case of xanthogranulomatous cholecystitis in a 45 year old woman, revealed by febrile abdominal pain. Case Report: The patient was 45 years old and had no particular pathological history. She presented with acute febrile abdominal pain. The clinical examination revealed a conscious patient, hemodynamically and respiratorily stable, febrile (fever 39°C), with abdominal defence of the right hypochondrium, the rest of the examination was without anomaly. An abdominal CT scan was requested urgently revealing a circumferential and regular parietal thickening of the gallbladder, hypodense with spontaneous contrast enhanced after injection of PDC measuring 12 mm of maximum thickness, with individualization of multiple fissured calculi, seat of air bubbles realizing the sign of "Mercedes-Benz sign", It is associated with an important infiltration of the mesenteric fat of the neighborhood. A complementary MRI scan with T1, T2, Diffusion, 3DMRCP sequence was performed, showing a parietal thickening in T1 hyposignal, T2 intermediate signal, diffusion hypersignal, multiple liquid structures in T2 hypersignal associated with multiple stones in signal void on all sequences, and a dilatation of the main bile duct measuring 13 mm upstream of a regular eccentric stenosis of the lower bile duct with an inflammatory appearance. Discussion and Conclusion: Xanthogranulomatous cholecystitis is a pathology that is difficult to diagnose preoperatively, as it can be mistaken for a vesicular adenocarcinoma. CT and MRI scans can sometimes help to clarify the diagnosis, particularly in the presence of a diffuse and continuous thickening of the wall with a con