A Case of Advanced Gallbladder Cancer with Right-sided Ligamentum Teres

Abstract

A 73-year-old man presented to another hospital with epigastralgia. Although he was diagnosed with angina pectoris and treated, a contrast-enhanced CT scan incidentally showed thickening of the gallbladder wall and enlarged lymph nodes. He was referred to our hospital and underwent surgery with the diagnos is of gallbladder cancer with right-sided ligamentum teres. Intraoperative findings showed no evidence of distant metastasis and duodenal invasion was suspected, so the patient underwent an extended cholecystectomy and subtotal stomach-preserving pancreatoduodenectomy. The gallbladder was unusually located ventral to the hepatoduodenal mesentery, which made the operation difficult. Hepatic resection was first performed up to the gallbladder plate to secure a view of the hepatoduodenal mesentery. The right-sided ligamentum teres is often associated with abnormal bifurcation of the hepatic ducts. Therefore, detailed preoperative imaging and careful intraoperative surgical manipulation are important.