A Case of Adenocarcinoma of the Gallbladder Which was Found by Umbilical Metastasis

Yoshiaki Murakami, Takashi Kodama, Yoshio Takesue, Mitsuaki Okita, Yuji Imamura, Hitoshi Sewake, Katsunari Miyamoto, Hiroaki Tsumura, Yuichiro Matsuura, Takashi Yokoyama*

First Department of Surgery, Hiroshima University School of Medicine
*Department of General Medicine, Hiroshima University School of Medicine

A 41-year-old woman with a chief complaint of a tumor of the umbilicus who had had right hypochondoraligia since her youth was diagnosed by ultrasonography, computed tomography and other examinations as having carcinoma of the gallbladder with umbilical metastasis. Cholecystectomy with partial hepatectomy, lymphnode dissection, partial resection of the transverse colon and resection of the umbilicus was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBDS) without dilatation of the biliary tract was revealed by intraoperative chorangiography. The disorders of liver function continued postoperatively due to regurgitation of pancreatic juice into the biliary tract. This case was a typical case of AAPBDS with carcinoma of the gallbladder, but was a rare case as carcinoma of the gallbladder with hematogenous or lymphogenous metastasis to the umbilicus. In carcinoma of the biliary tract in younger patients or those with chronic cholecystitis without gall stones who have had right hypochondoralgia since their youth, we should attempt careful examination while always keeping AAPBDS in mind. And we should select the pancreaticobiliary ductal diversion even for AAPBDS without dilatation of the biliary tract after dissection of the peribiliary lymphnodes, to prevent regurgitation of pancreatic juice into the biliary tract.

Key words
anomalous arrangement of the pancreaticobiliary ductal system without dilatation of biliary tract, adenocarcinoma of the gallbladder, metastasis to the umbilicus

Reprint requests
Yoshiaki Murakami First Department of Surgery, Hiroshima University School of Medicine
1-2-3 Kasumi, Minami-ku, Hiroshima, 734 JAPAN

Accepted
October 11, 1990

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