Abstract
We report a case of gallbladder carcinoma with anomalous pancreaticobiliary ductal union, complicated by metabolic acidosis caused by percutaneous transhepatic biliary drainage (PTBD). A 61-year-old man with obstructive jaundice due to gallbladder carcinoma was admitted with a PTBD catheter already inserted at the previous hospital. Arterial blood gas examination showed metabolic acidosis (pH7.355, HCO3-15.3 mmol/l, base excess-9.1mmol/l). We concluded that the external drainage of bile and pancreatic juice had caused metabolic acidosis. After a change to internal drainage, pH, HCO3- and base excess returned to normal. We conducted extended right hepatic lobectomy, pancreatoduodenectomy, right colectomy, and combined resection and reconstruction of the portal vein following percutaneous transhepatic right portal embolization. The postoperative course was uneventful. Metabolic acidosis should thus be recognized as a possible complication of biliary drainage in patients with anomalous pancreaticobiliary ductal union.
