Abstract
A 50-year-old woman with abdominal pain and a suspected biliary disorder was found in enhanced abdominal CT to have a nodular tumor 3cm in diameter in the body of the gallbladder, swollen lymph nodes in the hepa- toduodenal ligament that were suspected to have invaded the head of the pancreas, paraaortic lymph nodes (No.16b1) swollen to 1cm in diameter, and the right hepatic artery compressed by a swollen lymph node at the hepatic hilum. ERCP showed pancreaticobiliary maljunction without dilation of the common bile duct, a filling defect in the gallbladder, and a compressed common bile duct, leading to a diagnosis of advanced gall-bladder carcinoma with paraaortic lymph node metastasis and necessitating right hepatic lobectomy and pan-creaticoduodenectomy with regional and paraaortic lymphadenectomy. Histologically, the cancer was papil-lary adenocarcinoma with a depth of ss, lymph node Nos. 8p, 12b, 12p, 14, and 16b1 was positive and stage IVa.A pancreatic fistula was identified postoperatively. The woman was discharged on postoperative day 49, and is doing well without any sign of recurrence 3 years and 7 months later.
