Wang W, Korah M, Bessoff KE, Shen J, Forrester JD. Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report. World J Gastrointest Surg 2023; 15(3): 488-494 [PMID: 37032803 DOI: 10.4240/wjgs.v15.i3.488]
Corresponding Author of This Article
Joseph D Forrester, FACS, MD, MSc, Assistant Professor, Attending Doctor, Director, Surgeon, Division of General Surgery, Department of Surgery, Stanford University, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States. jdf1@stanford.edu
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Mar 27, 2023; 15(3): 488-494 Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.488
Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report
William Wang, Maria Korah, Kovi E Bessoff, Jeanne Shen, Joseph D Forrester
William Wang, Department of Biology, Stanford University, Stanford, CA 94305, United States
William Wang, Department of Bioengineering, Stanford University, Stanford, CA 94305, United States
Maria Korah, Kovi E Bessoff, Joseph D Forrester, Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, United States
Jeanne Shen, Center for Artificial Intelligence in Medicine and Imaging, Stanford University, Palo Alto, CA 94304, United States
Jeanne Shen, Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, United States
Author contributions: Wang W and Korah M contributed to manuscript writing and editing; Forrester JD was in charge of conceptualization, manuscript preparation and the patient case; Shen J contributed the gross and histopathologic images and descriptions; Wang W, Korah M, Bessoff KE, Shen J, and Forrester JD contributed to analysis; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph D Forrester, FACS, MD, MSc, Assistant Professor, Attending Doctor, Director, Surgeon, Division of General Surgery, Department of Surgery, Stanford University, 300 Pasteur Drive, H3591, Stanford, CA 94305, United States. jdf1@stanford.edu
Received: November 26, 2022 Peer-review started: November 26, 2022 First decision: January 3, 2023 Revised: January 15, 2023 Accepted: February 16, 2023 Article in press: February 16, 2023 Published online: March 27, 2023 Processing time: 120 Days and 16.3 Hours
Abstract
BACKGROUND
Xanthogranulomatous inflammation (XGI) is an uncommon process involving an accumulation of inflammatory cells, commonly lipid-laden macrophages. XGI has been described to occur throughout the body but only rarely in the lower gastrointestinal tract. We describe a case of XGI contributing to chronic obstructive symptoms in the terminal ileum, in which the patient had an initial diagnostic laparoscopy, continued to have symptoms, then proceeded to have the definitive treatment. To our knowledge, this is the first report of XGI associated with a prior small bowel anastomosis.
CASE SUMMARY
We report the case of a 42-year-old female who presented with intermittent epigastric pain and subjective fevers. She had undergone a laparoscopic small bowel resection for Meckel’s diverticulum five years prior. Her workup was notable for computed tomography scan demonstrating mild inflammation and surrounding stranding at the level of the prior anastomosis. She underwent a laparotomy, resection of the prior anastomosis and re-anastomosis, with final histopathological examination findings consistent with mural XGI.
CONCLUSION
XGI can occur at the site of a prior bowel anastomosis and cause chronic obstructive symptoms.
Core Tip: Xanthogranulomatous inflammation (XGI) is an uncommon inflammatory condition characterized by foamy histiocytes and other inflammatory cells. We report a rare case of XGI that occurred in the terminal ileum. Moreover, this is the first reported case of XGI associated with a prior bowel anastomosis. This case enhances our understanding of XGI and provides more insight into the pathophysiology of the condition.
