A Case of Extrahepatic Bile Duct Carcinoma Detected 3 Years after the Metallic Stent Therapy for Postoperative Bile Duct Stricture

Masaki Kajikawa, Akiharu Ishiyama and Kenro Sawada

Department of Surgery, Tosei General Hospital

A 70-year-old man admitted for back pain and liver dysfunction in 1993 and having a history of choledococholecystolithiasis surgery in 1977 was diagnosed as having recurrent choledocolithiasis, necessitating percutaneous transhepatic cholangioscopy and lithotomy (PTCS-L). An extrahepatic bile duct stricture was detected and diagnosed as benign by cholangioscopy and biopsy. Although the stricture was successfully treated by expandable metallic stent (EMS) insertion, he suffered from recurrent choledocolithiasis twice until 1996, each time requiring PTCS-L. The last PTCS showed a bile duct tumor protruding through the EMS mesh confirmed pathologically to be adenocarcinoma. Surgery and histopathological findings showed moderate to poorly differentiated adenocarcinoma accompanied by adenoma and hyperplasia arising from the bile duct mucosa below the EMS. This suggests a possible relationship between EMS and bile duct carcinoma, indicating that EMS treatment for benign bile duct stricture should be undertaken only after extremely careful consideration.

Key words
benign bile duct stricture, expandable metallic stent, bile duct carcinoma

Reprint requests
Masaki Kajikawa Department of Surgery, National Nagoya Hospital
4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 JAPAN

Accepted
October 29, 2003

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