Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
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
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.

Keywords: Xanthogranulomatous inflammation, Chronic obstructive symptoms, Terminal ileum, Bowel anastomosis, Bowel resection, Case report

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.