Port site and peritoneal metastases after laparoscopic cholecystectomy for incidentally found gallbladder carcinoma
A 59-year-old female patient presented with recurrent billiary colic and nausea. Her past medical history was not significant. Her physical examination was unremarkable. Ultrasonography of abdomen revealed choleliathiasis with no indication of tumor and normal common bile duct. Her liver function tests and other biochemical investigations were normal. Laparoscopic cholecystectomy was carried out with standard four trocar technique (two 10 mm and two 5 mm). Operative findings were edematous thick-walled gallbladder with severe inflammation in Calot's triangle. There was no evident spillage of bile inside peritoneum. There was no macroscopic evidence of tumor in the excised gallbladder mucosa. However, histological examination revealed well-differentiated adenocarcinoma confined to lamina propria, diagnosed having T1 gallbladder cancer with negative margins including cystic duct stump and no areas of deeper invasion. Considering her stage of gallbladder cancer, simple cholecystectomy was sufficient. The patient presented to us after 3 months with painful swelling at umbilicus and jaundice. Her abdominal ultrasonography revealed mass lesion 9 × 10 cm in the gallbladder fossa with two subcutaneous nodules, one at the umbilical port and the other at the midclavicular port. Her CT scan examination revealed similar findings with other peritoneal nodules. Patient refused further investigation and treatment.