A cholangiocarcinoma detected while treating intrahepatic stones 20 years after operative biliary diversion for congenital dilatation of the bile duct

Abstract

A 66-year-old man who had undergone biliary diversion for congenital biliary dilatation of the bile duct at the age of 46 years was admitted to our hospital, after developing a liver abscess complicating intrahepatic stones. After cholagioscopic lithotripsy, percutaneous transhepatic cholangioscopy disclosed a reddish, nodular lesion, 7 mm in diameter, in the right hepatic duct. Pathologic examination of biopsy specimen from the lesion indicated moderately differentiated adenocarcinoma. Because the patient had chronic hepatitis B and severe liver dysfunction, surgical treatment was not pursued. Brachytherapy using a remote after-loading system was not effective. Microwave coagulation therapy achieved satisfactory local control. This patient's course illustrates the risk of intrahepatic stones and cholangiocarcinoma after surgical treatment of congenital dilation of the bile duct; long-term follow-up is required. Here, percutaneous transhepatic cholangioscopy detected a cholangiocarcinoma at a relatively early stage.