PMC6251061_01
Computed Tomography Images. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.). Enhanced mass was shown at the tail of the gallbladder (blue triangle). Tumor was adjacent to the transverse colon (yellow triangle).
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U/ml. Ultra-sonographic images showed the low echoic mass in the fundus of the GB without any signal of blood flow (Fig. 1).
Endoscopic Ultrasonography Imaging. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.). The continuity of the 3rd layer was confirmed (blue triangle). The invasion depth was assumed to be subserosa.
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Endoscopic ultrasonography revealed the continuity of the 3rd layer of the gallbladder wall: invasion to the subserosa layer (Fig. 2).
Pathological Examination.. Poorly differentiated adenocarcinoma was shown. According to the classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (3rd English edition), S0; Hinf1; H0; Binf0; PV0; A0; P0; N0; M(-); ST(-); pT2; pStageII; BM0; HM0; EM0; CurA, were diagnosed.
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Pathological examination revealed the same progression stage as proposed preoperatively (Fig. 3).
Findings at the Emergency Intraoperative. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.). Emergency laparotomy revealed the ischemic bile leakage at the connecting points of the hepatic, cystic, and common bile duct (A, B): discoloring of the cystic duct. Ulceration and perforation in the root of the cystic duct was detected by intraoperative cholangioscopy after choledocotomy (C, D).. T-tube drainage was performed (E).
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Emergency laparotomy revealed ischemic bile duct leakage at the connecting points of the hepatic, cystic, and common bile duct; discoloration of the cystic duct; and ulceration and perforation at the root of the cystic duct (Fig. 4).
Indocyanine Green Near-Infrared Image. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.). Indocyanine Green Near-Infrared Image showed the flow of arterial network on the common bile duct (red arrow).
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After the recognition of the proper flow (Fig. 5), preservation of the extrahepatic biliary duct was selected.