Abstract
A 66–year–old woman seen for epigastralgia from the previous month was found in upper gastrointestinal (GI) endoscopy to have large gastric residue. Strictural biopsies showed moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed pyloric antrum thickening and swollen lymph nodes around the stomach. The preoperative diagnosis was lactic dehydrogenase (LD) gastric cancer, circ, type 3, T4a (SE) N1, stage IIIB.
Intraoperative findings showed the gall bladder and duodenal bulb involving the omentum with gall bladder cancer. The Gall bladder bed was resected and distal gastrectomy done with bile duct resection. The lower end of the common bile duct was ligated and the bile duct and jejunum anastomosed with Roux–en–Y reconstruction and Billroth II remnant stomach treatment. The redness of the resected antrum mucosa specimen and bile duct mucosa was normal. The final diagnosis was gastric gall bladder cancer invading the bile duct and stomach.
Gall bladder cancer had infiltrating the pylorus. Gall bladder atrophy necessitates considering the possibility of gall bladder cancer.
