A Case of Lower Bile Duct Cancer Developing 30 Years After Choledochoduodenostomy

Takahiro Sasaya, Akihiro Yamaguchi, Masatoshi Isogai, Tohru Harada, Yuji Kaneoka and Masahiko Suzuki

Department of Surgery, Ogaki Municipal Hospital

A 57-year-old man admitted with vomiting had undergone cholecystectomy and side-to-side choledochoduodenostomy about 30 years earlier. Blood test results at admission showed liver dysfunction, cholangitis, and slightly increased CA19-9. Contrast radiography of the upper digestive tract revealed an elevated lesion at the choledochoduodenostomy site in the duodenal bulb. Abdominal CT scans showed a tumor filling the lower bile duct and duodenum. Gastroscopy showed an elevated lesion with a smooth surface in the duodenal bulb. Biopsy of the lesion revealed well-differentiated adenocarcinoma. Under a diagnosis of duodenal cancer, we conducted pancreatoduodenectomy with combined resection of the portal vein. The tumor occupied the lower bile duct and had invaded the pancreas, indicating that it probably originated from the lower bile duct. The tumor extended superficially into the bile duct proximally to the anastomosis site, distally to the duodenal papilla, forming tumorous lesions. It is likely that reflux of digestive juice into the bile duct through the anastomosis site and long-term bacterial infection caused czncer to develop.

Key words
choledochoduodenostomy, bile duct cancer

Reprint requests
Takahiro Sasaya Department of Surgery, Ogaki Municipal Hospital 4-86 Minaminokawa-cho, Ogaki, 503-0864 JAPAN

Accepted
December 19, 2000

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