Abstract
An 80-year-old Japanese man had been hospitalized for acute cholangitis approx. 2 yrs prior to his admission to our institution. At that time, the use of intraductal ultrasonography (IDUS) during endoscopic retrograde cholangiopancreatography (ERCP) revealed common bile duct stones; they were removed during endoscopic therapy. The wall thickness of the bile duct was pointed out and then diagnosed as inflammatory wall thickness. The patient was subsequently hospitalized again for acute cholangitis, and at that time ERCP did not reveal stones or abnormality suggesting a neoplasm, but IDUS revealed 5-mm stones and diffuse wall thickness of the common bile duct (the max. thickness was 7mm). This was diagnosed as bile duct carcinoma by biopsy. The patient underwent a pancreaticoduodenectomy and extrahepatic bile duct resection. It was thought that the invasion depth was within the fiber muscular layer, but not all of the cancer was removed because it extended to intrahepatic bile ducts. This case indicates that clinicians should be aware of the potential existence of bile duct carcinoma during treatments for bile duct stones and should perform IDUS. If there is any abnormality in the bile duct wall, further biopsies should be performed.
