Abstract
A 71-year-old non-icteric female complaining of nausea, etc. was admitted because of abnormally elevated values of serum alkaline phosphatase and the dilated biliary ductal system on ultrasonography. Although endoscopic cholangiography was unsuccessful, a small neoplasm adjacent to the Vaterian papilla was suspected. No neoplastic change was identified on angiogram of the pancreaticoduodenal region. Intraoperative ultrasonography revealed a tumor on the lower bile duct (Bi) and pancreaticoduodenectomy was carried out. Histologically, stage I bile duct carcinoma invaded into pm was noted. The patient has been doing well 8 months after surgery without recurrence.
To our knowledge, 24 non-icteric patients of carcinoma of Bi including our own case have been reported in the Japanese literatures, among whom carcinoma in relatively early stage was noted in 19 (79%) and resection was performed in the majority. Although direct cholangiography was a usual diagnostic technique of this disease at non-icteric stage in consideration of abnormal liver functional and ultrasonographic findings, four patients could be diagnosed by intraoperative biopsy. In the present case, however, intraoperative ultrasonography was very advantageous for making decision of operative strategy.
