1Department of Surgery, Kizukuri Adult Disease Center Hospital, 2The Second Department of Surgery, Hirosaki University School of Medicine
Gallbladder cancer, Gallstone disease, Intraoperative ultrasonography, Biliary Surgery
We examined a case of a small carcinoma of the gallbladder (GB) detected by routine intraoperative ultrasonography (IOUS) for cholelithiasis. A 88-year-old woman was admitted to our hospital complaining of high fever and hypochondralgia. Immediate ultrasonography showed several stones in the GB. ERCP did not help us to reveal the GB because of an impacted stone in the cystic duct, but it demonstrated diagnose a choledochal stone and a duodenal diverticulum. On enhanced CT scan, gallstones and a partial thickening of the GB wall were recognized, but we could not diagnose of GB cancer. An 18 mm hypoechoic mass in the wall of the GB fundus was detected with IOUS. The sonogram suggested direct invasion to the liver. At surgery, combining choledocholithotomy, cholecystectomy with partial resection of the liver, and lymph node dissection, were performed. Subsequent histological examination, however, showed the tumor was confined to the subserosa of the GB wall. From our experience, we believe that IOUS examination is indispensable to avoid overlooking GB carcinoma which occasionally associates with cholecystolithiasis.