Abstract
An 82-year-old man was referred to our hospital for pain in the left shoulder, left side of the chest, and upper abdomen. Physical findings showed peritonitis. CT showed an abscess in the omental bursa. At the same time, bile duct dilatation was detected, and cholangiocarcinoma was suspected. Subsequently, an emergency operation with lavage drainage was carried out, opening the omental bursa. The bile juice flowed out from the left subphrenic drainage tube and obstructive jaundice was seen. MRCP showed lower bile duct cancer and PTBD was undertaken for the biliary drainage. After the biliary leakage was stopped, pancreaticoduodenectomy was carried out. Peritoneal dissemination was detected 4 months after the operation. Peritoneal seeding is the most difficult problem encountered in the case of spontaneous biloma due to cholangiocarcinoma.
