Abstract
We present a case of cancer of the cystic duct remnant developed after laparoscopic cholecystectomy. The case involved a man in his seventies who had undergone laparoscopic cholecystectony for chronic cholecystitis 18 years earlier, and operation for lung cancer at the department of respiratory surgety in our hospital five years earlier. An increase in the CEA level was detected by a follow-up examination in the clinic. PET-CT revealed abnormal uptake of FDG around the hepatic portal region. The patient was then referred to the department of gastroenterological medicine in our hospital. ERCP revealed stenosis at the middle bile duct and disruption of the cystic duct remnant at a portion about one cm apart from the confluence. Abdominal CT scan showed an about 2-cm diameter tumor with early blush at the cystic duct remnant just under a clip used for the previous cholecystectomy and comparatively intact continuity was kept in the lumen of the cystic duct. Cancer of the cystic duct remnant was diagnosed and subtotal stomach preserving panreaticoduodenectomy was performed. The lesion was a 3-cm diameter irregular tumor associated with stenosis encircling the entire cystic duct remnant. Cancer invasion into the common hepatic duct, the pancreas head and the duodenum as well as lymph node metastasis were confirmed. The patient experienced metastasis to the hepatic portal lymph nodes nine months and died 22 months after the operation.
