Background

A 56 year old male with complaints of hypertensive pain in the abdomen since 1 month and fever for 5 days. He was aware of having gall bladder stones since 2 years. On examination he had a tender palpable gall bladder but no jaundice.

Diagnosis

USG revealed a heterogenous gall bladder mass measuring 6 Cm with invasion of segment IV of the liver. CECT revealed a heterogenous mass of 6 Cm in the body and neck of the Gall Bladder extending up to the cystic duct and invading segments IV & V, liver indenting duodenum and multiple lymph nodes with the largest measuring 2cm. Upper GI endoscopy revealed no duodenal invasion.

Intra-Op Findings – there was a large mass in the body and neck of the Gall Bladder invading segments IV b & V with surrounding inflammatory omental adhesions, large pericholedochal lymph nodes with no surface liver metastasis or ascitis

Treatment

Extended cholecystectomy with resection of segments IV b & V of liver along with CBD excision and hepatoduodenal ligament clearance with hepaticojejunostomy was done . Post op was uneventful. Biopsy revealed well differentiated squamous cell carcinoma with free resected margins with one node positive.

He has been referred for adjuvant treatment.

CBD Excision and HDL clearence

Roux en Y Hepaticojejunostomy

CECT Abdomen showing a heterogeneously enhancing GB mass lesion infiltrating into the adjacent liver.

About Author –

Dr. M. Manisegaran, Consultant Surgical Gastroenterologist, Yashoda Hospital, Hyderabad
MS, M.Ch, DNB, MNAMS, FRCS (ED), FRS (ITALY)