Abstract
A 85-year-old man with fever and right upper quadrant pain was found in ultrasonography and computed tomography showed a thick wall of the gallbladder, and common bile duct stones. He was hospitalized with suspected acute cholecystitis and choledocholithiasis, and PTGBD was performed. The bile duct stones were removed by EST, but ERC could not evidence the cystic duct or gallbladder. Under a diagnosis of stone incarceration in the neck of the gallbladder, laparoscopic cholecystectomy was performed, and a tumor was detected in the cystic duct and diagnosed as adenocarcinoma by intraoperative pathological examination. We additionally performed bile duct resection with regional nodes laparoscopically, followed by Roux-en Y hepaticojejunostomy by laparotomy. Pathologically, this carcinoma was pT2 (ss), pN0, fStage II. It met Farrar's criteria for primary cystic duct carcinoma. No complications were observed and the patient was discharged on postoperative day 7. In the seven months since surgery, he has shown no signs of recurrence without postoperative adjuvant chemotherapy.
