Case Report
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World J Gastroenterol. Jul 14, 2014; 20(26): 8717-8721
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8717
Acute abdomen: Rare and unusual presentation of right colic xanthogranulomatosis
Paola Addario Chieco, Laura Antolino, Valentina Giaccaglia, Francesca Centanini, Gaetano Vincenzo Cunsolo, Alessandra Sparagna, Stefania Uccini, Vincenzo Ziparo
Paola Addario Chieco, Laura Antolino, Valentina Giaccaglia, Francesca Centanini, Gaetano Vincenzo Cunsolo, Alessandra Sparagna, Vincenzo Ziparo, Department of General Surgery, General Surgery 1 Unit, S. Andrea University Hospital, 00189 Rome, Italy
Paola Addario Chieco, Laura Antolino, Valentina Giaccaglia, Francesca Centanini, Gaetano Vincenzo Cunsolo, Alessandra Sparagna, Vincenzo Ziparo, Stefania Uccini, Department of Pathology, S. Andrea University Hospital, 00189 Rome, Italy
Author contributions: Antolino L, Centanini F, Cunsolo GV and Sparagna A contributed to acquisition of the data; Antolino L and Giaccaglia V contributed to analysis and interpretation of the data; Antolino L, Giaccaglia V, Cunsolo GV, Sparagna A and Uccini S contributed to drafting of the manuscript; Addario Chieco P, Giaccaglia V and Ziparo V contributed to critical revision of the paper.
Correspondence to: Paola Addario Chieco, MD, Department of General Surgery, General Surgery 1 Unit, S. Andrea University Hospital, Via di Grottarossa 1085, 00189 Rome, Italy. paddariochieco@ospedalesantandrea.it
Telephone: +39-6-33775693 Fax: +39-6-33775228
Received: February 1, 2013
Revised: April 23, 2013
Accepted: May 18, 2013
Published online: July 14, 2014
Processing time: 527 Days and 23.2 Hours
Abstract

Xanthogranulomatous inflammation (XGI) is a disease of unknown origin, most frequently described in the kidney and gallbladder; its localization in the colorectal tract is extremely rare. The extension of the typical inflammatory process to the surrounding tissues may lead to misdiagnosis as cancer. We report the case of a 56-year-old woman presenting to the Emergency Department with pain, increased levels of α1 and α2 proteins and C-reactive protein (17.5 mg/dL; normal value 0-0.5), and a palpable mass, localized in the right lower quadrant of the abdomen. A computed tomography scan showed a large right cecal mass with necrotic areas, local inflammation of retroperitoneal fat, and enlargement of local lymph nodes. Because of the high suspicion of colic abscess as well as malignancy and worsening of the clinical condition, the patient underwent right colectomy after 4 d of antibiotic treatment. Pathology revealed xanthogranulomatous inflammation involving the ileocecal valve. We review the reports of large bowel tract XGI in the international literature.

Keywords: Xanthogranulomatosis; Large bowel xanthogranulomatosis; Abdominal mass; Abdominal abscess

Core tip: Xanthogranulomatous inflammation (XGI) is a disease of unknown origin, most frequently described in the kidney and gallbladder, and extremely rare in the colon. The extension of inflammation to the surrounding tissues may lead to misdiagnosis as cancer. We report the case of a 56-year-old woman presenting to the Emergency Department with pain, increased levels of acute-phase proteins, and a palpable mass in the right lower abdominal quadrant. Computed tomography showed a large cecal mass with necrotic areas and enlarged lymph nodes. Due to suspicion of malignancy and worsening of the clinical conditions, she underwent right colectomy. Pathology revealed XGI of the ileocecal valve.