Granulomatous Biliary Stricture Mimicking Malignancy Managed by Laparoscopy: A Diagnostic and Therapeutic Challenge

Diagnosing biliary strictures remains challenging, as benign inflammatory conditions may closely simulate malignancy on clinical and radiological evaluation. With proper patient selection and surgical expertise, minimally invasive surgery (MIS) provides safe staging and definitive management without compromising oncologic principles for suspicious biliary strictures. We report a 30-year-old male presenting with painless progressive jaundice, weight loss, and cholestatic jaundice with imaging features suspicious for malignancy. Despite the endoscopic decompression, the cross-sectional imaging and tumor markers were inconclusive, necessitating surgical exploration. Also, as the pre-operative suspicion was of gall bladder malignancy involving the bile duct and not cholangiocarcinoma, work-up for cholangioscopic biopsy or cytology was not done, nor was any attempt made for the biopsy by the rendezvous technique. The patient underwent laparoscopic extended cholecystectomy with bile duct excision and biliary reconstruction, and histopathology revealed granulomatous cholecystitis with choledochitis without evidence of malignancy. Granulomatous biliary disease, although uncommon, frequently mimics gallbladder or biliary cancer. Post-operatively, the patient was further evaluated and found to be negative for sarcoidosis. This scientific case report underscores the importance of maintaining a high index of suspicion for benign inflammatory mimics and recognizing that histopathology remains the definitive diagnostic standard in granulomatous biliary strictures.