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BMJ Case Reports 2018; doi:10.1136/bcr-2018-226580
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Rare cause of gastric outlet obstruction: xanthogranulomatous cholecystitis

  1. Iqbal Singh4
  1. 1Department of Urology, King George’s Medical University, Lucknow, India
  2. 2Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
  3. 3Department of Radiotherapy, King George’s Medical University, Lucknow, India
  4. 4Department of Surgery, Urology Division, University College of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Gaurav Garg, gougarg{at}gmail.com
  • Accepted 25 August 2018
  • Published 10 September 2018

Description 

A 62-year-old Indian female patient presented with right upper quadrant pain and multiple episodes of vomiting for 10 days. She denied history of fever, jaundice, past anorexia/weight loss and previous surgeries. She was dehydrated, tachycardia (120/min) was present, and there was tenderness in the right upper quadrant. Routine investigations revealed presence of anaemia (haemoglobin 9.1 g/dL), raised total leucocyte counts (17 x10^9/L) and hypokalaemia (2.8 mEq/L). All other blood tests (liver function/kidney function/blood sugar and coagulation profile) were normal. Patient was stabilised with intravenous fluids, antibiotics and other supportive management. Imaging with ultrasound (USG) was suboptimal due to the massive intestinal gas and uncooperative nature of the patient. A collapsed gallbladder (GB) and a mass with a smooth curvilinear surface and posterior acoustic shadowing in the distal part of the duodenum were the only distinguishable findings. Due to repeated episodes of vomiting, the patient underwent an upper gastrointestinal endoscopy, which was suggestive of pyloric obstruction. For the further evaluation of GB mass in the USG …

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