Korean J Gastroenterol.  2016 May;67(5):277-281. 10.4166/kjg.2016.67.5.277.

A Case of Xanthogranulomatous Inflammation of Terminal Ileum Presenting as a Mass in a Woman with Severe Obesity

• Chon HK
• Kim SW

• KMID: 2164337
• DOI: http://doi.org/10.4166/kjg.2016.67.5.277

Abstract

Xanthogranulomatous inflammation is an acute or chronic inflammatory condition most frequently reported in pyelonephritis and cholecystitis. However, the involvement of the terminal ileum is extremely rare. Its clinical significance is that it can mimic a malignant lesion clinically and intraoperatively, as well as radiographically. A 34-year-old European ethnic female presented with gradually aggravated abdominal pain in right lower quadrant for 15 days. There was no significant medical, surgical or traumatic history, except class III obesity (BMI, 41.0 kg/m2). An abdominal CT showed about a 4.7×3.7 cm sized, mass-like lesion in the terminal ileum. Despite symptomatic treatment, her clinical symptoms did not improve. After six days, she underwent a laparoscopic ileocecectomy. Pathologic findings showed extensive inflammation with occasional multinucleated giant cells and aggregates of foamy histiocytes, consistent with xanthogranulomatous inflammation. Here, we present a case of xanthogranulomatous inflammation in the terminal ileum presenting as subacute abdominal pain and a mass on imaging study. Xanthogranulomatous inflammation should be added to the differential diagnosis of patients with a suspected mass-like lesion in the terminal ileum.

Keyword

Xanthogranulomatous; Morbid obesity; Ileum

MeSH Terms

Abdominal Pain
Adult
Cholecystitis
Diagnosis, Differential
Female
Giant Cells
Histiocytes
Humans
Ileum*
Inflammation*
Obesity
Obesity, Morbid*
Pyelonephritis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. CT scan of abdomen. Seen is an approximately 4.7×3.7 cm sized, mass-like lesion (white arrow) in the terminal ileum.

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  Fig. 2. Intraoperative laparoscopic findings. (A) Inflammation and phlegmon with adhesions between the terminal ileum and abdominal wall.(B) Abscess pocket with pus discharges of the terminal ileum.

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  Fig. 3. Gross finding of resected ileocecal segment. It revealed mass-like thickening of the mesenteric fat with hemorrhage and adhesion at the terminal ileum. White arrow, terminal ileum; white arrowhead, mass-like lesion; black arrow, ileocecal valve; black arrowhead, cecum.

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  Fig. 4. Microscopic findings (H&E) of the resected specimen (A) showed extensive inflammation with occasional multinucleated giant cells and fibrosis (×100). (B) Higher magnification revealed aggregates of foamy histiocytes (×400).

Reference

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