Abstract
A 57-year old-man was admitted to our hospital with obstructive jaundice. Abdominal multi-detecter row CT (MDCT) demonstrated a biliary tumor at the hepatic confluence with intrahepatic bile duct dilatation. The right posterior portal vein was first ramified from the main portal trunk. The portal bifurcation of the left and right anterior portal veins was possibly involved by the tumor. Cholangiography showed a stricture of the extrahepatic bile duct from the hepatic hilus to the lower bile duct. Considering the residual liver volume and the anatomical variation of the portal vein, left trisectionectomy with caudate lobectomy plus pylorus preserving pancreatoduodenectomy was performed. Histologically, diffusely spreading bile duct cancer invaded the liver and pancreas. Resectional procedure should be determined considering both operative radicality and risk.
