Abstract
The case of a 58-year-old man with a history of resection of the extrahepatic bile duct and hepaticojejunostomy for congenital biliary dilatation at the age of 32 years is reported. The patient visited another hospital with a chief complaint of anorexia and was referred to our hospital after a pancreatic head tumor was detected. Computed tomography (CT) showed a dilated common bile duct at the pancreatic head and a tumor lesion, 40 mm in size, adjacent to the same region. On magnetic resonance cholangiopancreatography (MRCP), a dilated intrapancreatic bile duct was seen near the tumor. A residual intrapancreatic bile duct cancer following the surgery for congenital biliary dilatation was diagnosed, and subtotal stomach-preserving pancreaticoduodenectomy was performed. The results of pathological examination revealed advanced lower bile duct cancer accompanied by metastasis to lymph node No. 16. The patient is currently undergoing adjuvant chemotherapy, with no recurrence as of five months postoperatively. Investigation of reports in Japan of cancer developing following surgery for congenital biliary dilatation showed that the cancer had developed from the residual intrapancreatic bile duct in three of the four cases of the development of Totani classification type I cancer. Because it was thought that carcinogenesis can be inhibited by shortening the length of the residual intrapancreatic bile duct during initial surgery, compliance with bile duct resection directly above the pancreatic duct is important.
