Abstract
We present a case of gall stone ileus caused by unresectable perihilar cholangiocarcinoma (pCCA). The patient was a 75-year-old-man who had had the diagnosis of pCCA which was considered to be unresectable due to peritoneal metastases. Thus the patient was treated by chemotherapy consisting of gemcitabine and S-1. Eleven months after the diagnosis of pCCA, the patient suffered from gallstone ileus. Findings of celiotomy for gallstone ileus showed that peritoneal metastases were eradicated, suggesting that chemotherapy was markedly effective. Thus we considered early resumption of chemotherapy was preferred. Remaining gallstones in the gallbladder were small and considered to be unlikely to cause ileus thereafter. Hence, cholecystoduodenal fistula causative of gallstone ileus was left untreated and we only performed removal of impacted gallstone. After surgery, the patient recovered uneventfully. Therefore, chemotherapy was recommenced early postoperatively. The patient is currently doing well and receiving chemotherapy 48 months after the initial diagnosis of pCCA. Efficacy of chemotherapy for unresectable cholangiocarcinoma has been improved and thus number of long-term survivors with this dismal condition will increase. Because coexistence of gallstone and cholangiocarcinoma is common, gallstone ileus is rare but should be taken into consideration of long-term complication accompanying patients with unresectable cholangiocarcinoma.
