case_images: PMC10869450_01
case_images: Timeline of patient's treatment.
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case_images: He initially presented with right hypochondrium pain and jaundice ( Figure 1 ).
case_images: Initial MRI (left) and CT (right) scans demonstrating soft tissue mass involving the common hepatic duct bifurcation, cystic duct and gallbladder.
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case_images: f2
case_images: Gadobutrol-enhanced magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CT) scans of the abdomen revealed a 2.5 by 1.6-centimetre Bismuth-Corlette type 3B irregular infiltrative soft tissue thickening involving the common hepatic duct bifurcation and left hepatic ducts, with resultant bilateral intrahepatic bile duct dilatation ( Figure 2 ).
case_images: Interval CT scan after right portal vein embolisation demonstrating new 2-centimetre intra-peritoneal soft tissue lesion (white arrow), suspicious for peritoneal metastasis:this was eventually confirmed on diagnostic laparoscopy and biopsy.
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case_images: f3
case_images: Furthermore, this scan revealed small volume ascites and an enhancing 2.0 by 1.8-centimetre soft tissue lesion at the right subhepatic region with reticulation of the adjacent omentum, which was radiologically suspicious for peritoneal metastasis ( Figure 3 ).
case_images: Clinical photograph of bisected specimen showing post-embolisation changes - there were no liver metastases on gross pathology or on microscopic examination.
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case_images: f4
case_images: Stratafix  PDS 4-0 (Ethicon, New Jersey, United States) in a single-layer continuous technique. Specimen extraction was via the umbilical incision ( Figure 4 ).