Abstract
A 42-year-old man was referred to the hospital because of impaired hepatic function pointed out at a medical checkup. Abdominal CT scan and abdominal ultrasonography showed a tumorous lesion in the medial segment of liver, and then the patient was admitted for the purpose of close exploration and treatment. Abdominal magnetic resonance imaging (MRI) revealed obstruction of the left intrahepatic bile duct and an irregular finding at the bifurcation in the right anteroposterior segment. Abdominal angiography showed complete obstruction of the left branch of the portal vein and stricture in the vicinity of the lateral bifurcation of the main trunk of the portal vein. From these findings, unresectable bile duct cancer was diagnosed. We thus performed relief of obstructive jaundice, followed by administration of gemcitabine at a dose of 400mg/body/week and irradiation at a dose of 50.4Gy. Abdominal MRI performed 3 months later showed shrinkage of the tumor, and that performed 6 months later could not visualize the tumor. Thereafter, when nine months had elapsed after the initiation of treatment, the patient developed hemolytic uremic syndrome (HUS) and died 2 months after the onset of HUS despite plasma exchange and other treatments.
The prognosis of unresctable bile duct cancer is poor. This paper deals with our experience with such a patient who developed HUS, which might be caused by gemcitabine, with a fatal course after a remission had once been attained by chemoradiation therapy. Some bibliographical comments are also presented.
