A CASE OF DOUBLE CARCINOMA OF THE BILE DUCT AND PANCREAS ASSOCIATED WITH MIDGUT MALROTATION

Abstract

This paper describes a case of double carcinoma of the bile duct and pancreas associated with midgut malrotation and thick colateral vein toward the liver due to obstruction of the portal vein by the pancreas cancer. A 68-year-old female was admitted to the hospital because of jaundice. Percutaneous transhepatic cholangiography showed a stenosis 2 cm in diameter in the hepatic hiral bile duct, and percutaneous transhepatic cholangiodrainage was performed. Carcinoma cells were evidenced by the cytology of the bile and bile duct brushing. Endoscopic retrograde cholangiopancreatography revealed on obstruction of the main pancreatic duct in pancreas head. Angiography revealed encasements of the common hepatic artery and splenic artery, an obstruction of the portal vein in the pancreas head, and a thick colateral vein toward the liver along the hepatoduodenal ligament. The operative findings included a hepatic hiral bile duct tumor and carcinoma of the whole pancreas. Resection of the hepatic hiral bile duct and choledochojejunostomy were performed. It is inferred that the thick colateral veins toward the liver along hepatoduodenal ligament developed, because the pancreas head, duodenum and ascending colon were not fixed to the retroperitoneum due to midgut malrotation. Histopathologically the resected bile duct and pancreas showed well differetiated adenocarcinoma which were considered double cancer.