A Case of Gallbladder Cancer with Duplication of Common Bile Duct and Anomalous Junction of Pancreaticobiliary Duct

Seigou Mizumoto, Yoshimi Hitani, Hideo Akashi, Masaya Sasaki, Eiji Kurokawa^*, Hitoshi Yamamoto^*, Kinya Okano^**, Haruo Taniguchi^**, Kouji Takami^*** and kouji Umeshita^****

Department of Surgery, Numakuma Hospital
^*Department of Surgery, Minoo City Hospital, ^**Department of Pathology, Minoo City Hospital,
^***Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease,
^****Osaka University medical School, Department of Operation Center

We treated an extremely rare case of gallbladder cancer with duplication choledochus and anomalous junction of the pancreaticobiliary duct. A 75-year-old woman was admitted to the Department of Surgery at Minoo City Hospital for evaluation of a gallbladder tumor and radical surgery of the biliary tract. Subsequent examination including abdominal computed tomography (CT) indicated the tumor may be cancerous, so we conducted extended cholecystectomy and lymphadenectomy of the hepatoduodenal ligament. Intraoperative cholangiography showed the patient had an inverted Y-shaped double choledochus and anomalous junction of the pancreaticobiliary duct. Intraoperative frozen section diagnosis suggested the cystic duct was involved adenocarcinoma.
Additional surgery to resect the choledochus and reconstruct the biliary tract were then done. Unfortunately the patient contracted severe postoperative colitis due to mechicillin-resistant staphylococcus aureus, which developed into acute renal failure and gastrointestinal hemorrhage, with the woman dying on 30 postoperative day due to multiple organ failure.
Permanent section histology of the cystic duct showed moderate mucosal atypia but no invasion or occurrence of adenocarcinoma. The gallbladder contained I polypoid and multiple adenocarcinoma foci induced by chronic chemical irritation of bile mixed with pancreatic juice. These anomalies appeared due to maldevelopment of the hepatic antrum in the hepatic diverticle and dorsal pancreas in the early fetal stage, but no embryological conclusion could be made about these anomalies.

Key words
duplication of common bile duct, anomalous junction of pancreaticobiliary duct, gallbladder cancer

Reprint requests
Seigou Mizumoto Department of Surgery, Numakuma Hospital 469-3 Nakasanna, Numakuma-chou, Numakuma-gun, Hiroshima, 720-0402 JAPAN

Accepted
January 22, 2003

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