Abstract
A 71-year-old woman who complained of vomiting was admitted to our hospital because abdominal computed tomography detected bowel obstruction due to gallstone. C reactive protein markedly elevated although white blood cell counts were not elevated, and serum concentrations of CEA and CA19-9 were within normal range. Gastrointestinal imaging showed cholecystduodenal fistula, aircholangiogram, and gallstone in the ileum. We diagnosed gallstone ileus. An ileus catheter was inserted, and surgery was performed when renal function recovered. A gallstone 3 cm in diameter was found in the ileum 100 cm on the oral side of the ileocecal valve, and atrophic gallbladder with cholecystoduodenal fistula was found. We performed cholecystectomy with resection of the fistula and removed the gallstone in the small intestine. Microscopically, cancer cells were found in the gallbladder mucosa, and immunohistochemically, cancer cells were positive for p53 antibody and MIB-1 antibody respectively. Pseudo-pyloric gland type metaplasia was found in non-tumorous mucosa, however intestinal metaplasia was not found. Finally, intramucosal gallbladder carcinoma was diagnosed, and the surgical margin was positive. Additionally, a curative resection was performed after 2 months from the first operation. Biliary carcinoma must be carefully considered in patients with internal biliary fistula.
