A Case of Adenocarcinoma of the Gallbladder Which was Found by Umbilical Metastasis

A 41-year-old woman with a chief complaint of a tumor of the umbilicus who had had right hypochondoraligia since her youth was diagnosed by ultrasonography, computed tomography and other examinations as having carcinoma of the gallbladder with umbilical metastasis. Cholecystectomy with partial hepatectomy, lymphnode dissection, partial resection of the transverse colon and resection of the umbilicus was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBDS) without dilatation of the biliary tract was revealed by intraoperative chorangiography. The disorders of liver function continued postoperatively dueto regurgitation of pancreatic juice into the biliary tract. This case was a typical case of AAPBDS with carcinoma of the gallbladder, but was a rare case as carcinoma of the gallbladder with hematogenous or lymphogenous metastasisto the umbilicus. In carcinoma of the biliary tract in younger patients or those with chronic cholecystitis without gall stones who have had right hypochondoralgia since their youth, we should attempt careful examination while always keeping AAPBDS in mind. And we should select the pancreaticobiliary ductal diversion evenfor AAPBDS without dilatation of the biliary tract after dissection of the peribiliary lymphnodes, to prevent regurgitation of pancreatic juice into the biliary tract.