経皮経肝胆囊ドレナージ経路での胆囊鏡検査により診断しえた 急性胆囊炎を伴う胆囊癌の1 例

The patient was a 67-year-old man with suspected gallbladder cancer based on findings of a thickened gallbladder wall and lymphadenopathy on abdominal CT, abnormal accumulation in the same area on FDG-PET, and elevated tumor markers in blood tests in August 2018. In September of the same year, abdominal pain appeared and the patient was admitted to hospital with a diagnosis of acute cholecystitis. Because of the post-gastrectomy condition, endoscopic drainage of the gallbladder was judged to be difficult, and percutaneous transhepatic gallbladder drainage was performed. Thereafter, we performed repeated biopsy of the gallbladder and bile cytology via the puncture route, but with no malignant pathological findings. Percutaneous transhepatic cholecystoscopy biopsy was performed for definitive diagnosis, and a diagnosis of adenocarcinoma was obtained. After embolization of the right branch of the portal vein, right hepatectomy and extrahepatic bile duct resection were performed. Pathological results showed papillary adenocarcinoma. The patient is alive and recurrence-free 29 months after surgery. The number of reoperations after gastrointestinal tract reconstruction has increased, and percutaneous transhepatic diagnostic and therapeutic procedures may be required, but careful follow-up with consideration of the possibility of recurrence is also necessary.