Bile Granuloma Mimicking Peritoneal Seeding: A Case Report.

Area of Science:

• Gastroenterology
• Surgical Pathology
• Abdominal Imaging

Background:

• Laparoscopic cholecystectomy is a standard procedure for gallstones.
• Complications like foreign body granulomatous reactions are rare.
• Bile or gallstone spillage can lead to unusual inflammatory responses.

Purpose of the Study:

• To report a rare case of bile granuloma formation after laparoscopic cholecystectomy.
• To emphasize the potential for bile granulomas to mimic peritoneal malignancy.
• To improve postoperative surveillance and patient management.

Main Methods:

• Case presentation of a 59-year-old male with right upper quadrant pain.
• Laparoscopic cholecystectomy for acute cholecystitis and cholelithiasis.
• Postoperative imaging (CT, PET-CT) and subsequent surgical resection for suspected peritoneal seeding.

Main Results:

• Pathology revealed incidental adenocarcinoma and acute cholecystitis.
• Postoperative imaging showed a subhepatic nodule with hypermetabolism.
• Surgical specimens unexpectedly showed multiple bile granulomas, not peritoneal seeding.

Conclusions:

• Bile granulomas can present as suspicious nodules mimicking peritoneal metastasis after cholecystectomy.
• Radiological findings of hypermetabolism can be misleading.
• Increased awareness is crucial to prevent misdiagnosis and unnecessary aggressive surgical interventions.