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Biliary Granulomatous Peritoneal Reaction as Consequence of Cholecystectomy: Case Report and Literature Review

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Abstract

Bile or gallstone spillage during laparoscopic cholecystectomy occurs in 13 to 40% of cases of surgical dissection and extraction of a very inflamed gallbladder with friable or gangrenous walls. We present a case of a patient who developed a biliary granulomatous peritoneal reaction as consequence of cholecystectomy for acute-on-chronic cholecystitis. Our patient, after about 2 years from the surgery, in the follow-up imaging studies, showed multiple nodules disseminated in the peritoneal cavity suggestive for malignancy both on abdomen computer tomography scan and on positron emission tomography. Thus, laparoscopic nodulectomy lastly allowed the histologic diagnosis of biliary peritoneal granulomatous reaction. Even with benign assessment of nodules’ nature, these lesions showed a progressive trend of increasing over time in number and dimensions. We performed PubMed research of all cases reported in the literature to examine the cases features and to compare our findings with other clinical experiences reported by eleven international canters. Many patients were completely asymptomatic; as an occasional finding mimicking peritoneal seeding, further assessment to define the benign nature of these nodules were performed, so they underwent surgical treatment. The development of multiple abdominal nodules resulting from a foreign-body granulomatous reaction to bile/gallstones is a quite rare event after laparoscopic cholecystectomy, but we believe it should be seriously considered in patients who have undergone complicated surgical procedures on biliary tracts.

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Data Availability

Data and material of case report are available for eventual evaluation by reviewers.

Code Availability

Not applicable.

Abbreviations

CT:

Computed tomography

LC:

Laparoscopic cholecystectomy

IPMN:

Intraductal papillary mucinous neoplasm

PET-TC:

Positron emission computed tomography

US:

Ultrasound

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Authors and Affiliations

  1. Unit of Clinic of Gastroenterology, Hepatology, Hospital of Ancona, Università Politecnica Delle Marche, Via Conca 71, Ancona, AN, Italy

    Giuseppe Tarantino, Maria Eva Argenziano & Antonio Benedetti

  2. Unit of Internal Medicine, Civitanova Marche Hospital, ASUR Marche-AV3, Ancona, Italy

    Denise Menghini

  3. Unit of General and Microinvasive Surgery, Hospital of Ancona, Università Politecnica Delle Marche, Ancona, Italy

    Miriam Palmieri & Mario Guerrieri

  4. Unit of Pathology and Histology, Università Politecnica Delle Marche, Ancona, Italy

    Alessandra Mandolesi

  5. Unit of Transplant and Hepatobiliary Surgery, Hospital of Ancona, Università Politecnica Delle Marche, Ancona, Italy

    Enrico Dalla Bona

  6. Unit of Medical Clinic, Hospital of Ancona, Università Politecnica Delle Marche, Ancona, Italy

    Maria Giovanna Danieli

Authors
  1. Giuseppe Tarantino
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  2. Denise Menghini
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  3. Maria Eva Argenziano
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  4. Miriam Palmieri
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  5. Alessandra Mandolesi
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  6. Enrico Dalla Bona
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  7. Antonio Benedetti
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  8. Mario Guerrieri
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  9. Maria Giovanna Danieli
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Contributions

All the authors, who have participated actively in the study, are familiar with the data presented; they have seen and approved the manuscript and consent to publication. Giuseppe Tarantino and Denise Menghini were involved in clinical management of patient and wrote the manuscript. Maria Eva Argenziano and Miriam Palmieri performed bibliographic research. Alessandra Mandolesi performed histopathological investigations. Enrico Dalla Bona was involved in surgical management of the patient. Antonio Benedetti, Mario Guerrieri e, and Giovanna Danieli reviewed the manuscript for critical and intellectual implementations.

Corresponding author

Correspondence to Giuseppe Tarantino.

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Ethics Approval

The study is conforms to the ethical principles of the Declaration of Helsinki of the World Medical Association (Clinical Research 1966; 14: 03) and meets all the requirements governing informed consent in our country.

Consent to Participate

The patient’s consent was obtained before managing sensible data, even if in the cryptic format.

Consent for Publication

The patient’s consent to the publication of data was achieved, and a statement was acquired by me.

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The authors declare no competing interests.

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Tarantino, G., Menghini, D., Argenziano, M.E. et al. Biliary Granulomatous Peritoneal Reaction as Consequence of Cholecystectomy: Case Report and Literature Review. SN Compr. Clin. Med. 5, 152 (2023). https://doi.org/10.1007/s42399-023-01495-z

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