Case of Gallbladder Cancer Associated with Pancreaticobiliary Maljunction and Compression at the Retropancreatic Portion of Common Bile Duct by Right Hepatic Artery

Shogo Tanaka, Kazuhiro Hirohashi, Hiromu Tanaka, Shoji Kubo, Hiroyuki Hamba, Taichi Shuto, Junya Murase, Takashi Ikebe^*, Kenichi Wakasa^* and Hiroaki Kinoshita

Second Department of Surgery, Osaka City University Medical School
^*Department of Pathology, Osaka City University Hospital

A 39-year-old woman was admitted to our hospital because of repeated back pain. Abdominal ultrasonography (US) and computed tomography (CT) demonstrated a protruding lesion occupying the gallbladder. The lesion in the gallbladder and subsegments 4a and 5 of the liver were extensively stained during both contrast-enhanced CT and CT during arteriography. The operative cholangiogram and high bile amylase activity (160, 000 IU/L) indicated the pancreaticobiliary maljunction. The retropancreatic portion of the common bile duct (CBD) was compressed by the right hepatic artery (RHA), which originated from the gastroduodenal artery and coursed immediately ventral to the CBD. Cholecystectomy, combined resection of subsegments 4a and 5 of the liver and extrahepatic bile duct, lymph node dissection, and hepaticojejunostomy were performed, on the basis of a diagnosis of gallbladder cancer. Histologically, the gallbladder lesion was diagnosed as papillary adenocarcinoma with minimal invasion (5 mm) of the gallbladder fossa of the liver. The extensive staining in the liver on contrast CT was explained as an effect of abundant portal flow returning from the cystic vein. Generally, patients with pancreaticobiliary maljunction without choledoclocal cyst have few symptoms. However, compression of the CBD in the retropancreatic portion by the RHA seemed to be one of the causes of the cholangitis-like symptoms.

Key words
abnormality of right hepatic artery, gallbladder cancer, pancreaticobiliary majunction

Reprint requests
Shogo Tanaka Second Department of Surgery, Osaka City University Medical School 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585 JAPAN

Accepted
November 13, 1998

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