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+A 50-year-old lady presented with complaints of pain abdomen and jaundice for one and a half months; she also complained of intermittent type of fever in the last 1 week.
+Physical examination revealed presence of icterus and a palpable tender globular mass in the right hypochondrium measuring 3 × 3 cm.
+A clinical diagnosis of obstructive jaundice secondary to periampullary carcinoma was made.
+Ultrasonographic examination of the abdomen and pelvis revealed dilatation of the intrahepatic biliary radicles (IHBR), with multiple freely mobile gall stones and a dilated common bile duct (CBD) measuring 1.8 cm with sudden narrowing at its distal end.
+CT scan showed moderate dilatation of the extra and intrahepatic biliary radicles, cholelithiasis with suspicious thickening of the gall bladder wall at the fundus, and a distal CBD stricture.
+There was no evidence of any distant metastasis (Fig.1).
+A preoperative diagnosis of periampullary carcinoma with chronic cholecystitis was made, and the patient planned for a pancreaticoduodenectomy (Whipple’s procedure) after optimization.
+The patient underwent a classical Whipple’s procedure; table examination of the resected specimen revealed multiple gall stones in the gall bladder with area of mucosal thickening at the fundus and an irregular circumferential growth involving the intrapancreatic portion of the CBD.
+Postoperative period was uneventful, and the patient recovered satisfactorily.
+Histopathological examination of the resected specimen (Figs.2 and ​3) revealed thickening of the gall bladder wall at the fundus with multiple small calculi, the largest measuring 1.4 cm (Fig.3).
+Sections studied from the area of thickening showed features suggestive of adenocarcinoma limited to the mucosa.
+Microscopic sections obtained from the distal CBD region showed adenocarcinoma of the common bile duct with invasion into the muscular wall of the duodenum.
+Sections studied from the resected lymph nodes were free of tumor cells.
+A pathological staging of pT1aN0M0 for adenocarcinoma of the gall bladder and pT2N0M0 for adenocarcinoma of the distal CBD was made, and the patient was not subjected to any adjuvant therapy.
+The patient was disease-free 2 years after surgery.