Abstract
A 70-year-old woman who had undergone cholecystectomy for cholelithiasis 22 years earlier visited us complaining of abdominal pain, and was diagnosed as having dilatation of the intrahepatic bile duct. Abdominal CT showed an enhancing nodule in the upper part of the common bile duct and right hepatic duct. Malignancy could not be excluded, although a biopsy obtained from the stenosed area of the bile duct revealed no malignant cells. Therefore, we performed extended right lobectomy and extrahepatic bile duct resection with lymph node dissection after percutaneous transhepatic portal vein embolization. The patient was discharged 24 days after the surgery without complications. Histopathology of the resected specimen showed a submucosal tumor with smooth mucosa. The tumor was composed of hyperplastic nerve fibers with no evidence of malignant cells. Postoperative histopathological examination confirmed the diagnosis of bile duct amputation neuroma, which was thought to have arisen as a result of nerve fiber injury around the right hepatic bile duct during the earlier biliary surgery. Amputation neuroma of the bile duct is difficult to differentiate from cancer of the bile duct, especially in the hilar bile duct area. In cases presenting with ductal stenosis after biliary surgery, the possibility of this type of pathology should be kept in mind.
