Ruptured Gallbladder Cancer in the Bile Ducts Does Not Always Have a Poor Prognosis

The rupture of hepatobiliary malignancy in the main bile duct is a situation described as very bad and sign of an outdated tumor as hepatocellular carcinoma. Gallbladder cancer rupture in the main bile duct is yet not well-known condition. We report here eleven cases of patients who presented this complication.

Casuistic: These are twelve patients with eight females and four males with an average age of 55.6 years (40 - 77 years).The jaundice and cholangitis are the most symptoms presented by the patients. Only in one case, diagnosis was suspected before the surgery. Macroscopically, the tumor was either polypoid and/or diffuse. Microscopically, eleven case were adenocarcinoma and one epidermoid carcinoma. Two tumors were classified pT1, 3cases had invasive form but localized to gallbladder (p T2 and pT3), and seven were extended to neighboring viscera or metastatic (pT4).

The rupture recognizes three mechanisms: the first was free (tumor debris or mucin conglomerate), the second was infiltrative form (invading gradually the biliary wall) and the third was the association of the previous mechanisms. We carried out a curative treatment with total extraction of the tumor debris or bile resection for elevenpatients. One patient benefited from diversion by prosthesis. One patient presented postoperative residual tumor debris successfully extracted by endoscopic sphincterotomy. One patient died from a digestive hemorrhage and another died from an undetermined cause. On long-term follow-up, four patients are alive without disease at 240, 127, 120 and 48months.Six patients died of their disease at 5 months, 22 months, 22 months, 35months, 44 months and 45months.

Conclusion: Gallbladder cancer rupture in the main bile duct is not always the result of advanced cancers and treatment for curative purposes should always be attempted. The most favorable case is the presence of free tumor debris in the bile duct, the extraction of which associated with radical treatment of the disease can give rise to long-term survival.

Keywords: Tumor rupture - Main bile duct –free rupture – infiltrative rupture – long-term survival.