Extended Cholecystectomy with CBD Excision for Squamous Cell Carcinoma of Gall Bladder
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.
gall bladder cancer invading segment IV b & V Liver
CBD Excision and HDL clearence
CBD Excision with HDL clearence
Closure of distal CBD stump
Roux en Y Hepaticojejunostomy
CBD Excision with HDL clearence
CECT Abdomen showing a heterogeneously enhancing GB mass lesion infiltrating into the adjacent liver.
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