婦人科腹腔鏡手術時に偶発的に発見した胆管癌の一例

抄録

　Laparoscopic surgery allows for visualization of the entire abdominal cavity, in addition to the pelvic area. Therefore, we rarely identify abnormalities of the upper abdomen. We report a case in which a swollen gallbladder discovered during laparoscopy led to the diagnosis of cholangiocarcinoma.

　A 58-year-old patient (gravida 5, para 2) presented to our outpatient department with lower abdominal pain. She was diagnosed with degenerating uterine myoma on MRI. Although she was already menopausal, both ovaries were conserved. She wished for a complete cure; thus, we decided to perform total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. During the operation, we incidentally detected gallbladder swelling. There were no signs of tumor dissemination. Postoperatively, blood tests revealed abnormal hepatic function, and therefore CT was performed to examine the area around the liver. The findings raised the suspicion of cholangiocarcinoma or pancreatic head cancer. Liver biopsy led to the histological diagnosis of adenocarcinoma, but did not confirm the identity of the primary tumor. On the basis of the results of CT, endoscopic retrograde cholangiopancreatography, and liver biopsy, the patient was diagnosed with cholangiocarcinoma. Anticancer treatment was administered.