A Case of Xanthogranulomatous Appendicitis Treated by Laparoscopic Appendectomy

Abstract

A 38-year-old woman presented at a local clinic with a five-day history of lower abdominal pain. There was a slightly tender, palpable, 5-cm mass in the right lower quadrant. Blood tests showed mild elevation of the inflammatory response, and contrast-enhanced abdominal computed tomography showed that the appendix was enlarged, with an internally homogenous hypodense region suggestive of an abscess. Perforated appendicitis was suspected, and antibiotic treatment was initiated, but the differential diagnosis also included other conditions such as appendiceal mucocele. After the patient was transferred to our hospital, surgical resection was performed for diagnostic and therapeutic purposes. Intraoperatively, the tip of the appendix was covered by the greater omentum, but there was no sign of abscess formation, and only the appendiceal root was enlarged. Laparoscopic appendectomy was completed. There were no postoperative complications, and the patient was discharged improved on postoperative day 5. The resected specimen contained a pale yellowish area of appendiceal mucosa and surrounding fat, and pathological examination showed invasion by a large number of foamy histiocytes, leading to a diagnosis of xanthogranulomatous appendicitis, a rare disease. In most cases, a malignant tumor is suspected preoperatively, and extended surgery is performed. This case is reported along with a discussion of the literature.