case_images: PMC11100399_01
case_images: Abdominal ultrasonography: (a) an oval hyperechoic mass distal to the dilated common bile duct (CBD) and (b) dilated intrahepatic bile ducts throughout the liver
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case_images: EHBO appeared to be caused by intraluminal obstruction by the mass (Figure 1).
case_images: Schematic representation of the surgical procedure: (a) the mass in the common bile duct (asterisk) and the site of duodenal perforation (star); (b) diagonal lines indicating the resected areas; and (c) Billroth II gastrojejunostomy combined with Braun anastomosis and choledochoduodenostomy
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case_images: The proximal CBD was approximately 20 mm dilated and adherent to the duodenum (Figure 2a). The mass and perforation site were resected, followed by a choledochoduodenostomy with the Billroth II procedure (Figure 2b,c). Finally, the middle of the loop was anastomosed to the ventral aspect of the stomach (side-to-side gastrojejunostomy) in an isoperistaltic fashion, using the same material (Figures 2 and 3).
case_images: Surgical procedure: (a) ligation of the common bile duct distal to the mass; (b) duodenal perforation; (c) partial gastrectomy and choledochoduodenostomy; (d) Braun anastomosis; and (e) gastrojejunostomy
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case_images: Finally, the middle of the loop was anastomosed to the ventral aspect of the stomach (side-to-side gastrojejunostomy) in an isoperistaltic fashion, using the same material (Figures 2 and 3).
case_images: Histopathological and immunohistochemical findings: (a) the tumour is highly cellular with a small lobular pattern surrounded by a thin fibrovascular stroma (haematoxylin and eosin, bar = 50 microm); (b) tumour cells are diffusely immunopositive for synaptophysin (immunohistochemistry, bar = 50 microm); and (c) tumour cells are partially immunopositive for gastrin (immunohistochemistry, bar = 50 microm)
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case_images: Based on histological and immunohistochemical findings, the mass was diagnosed as a neuroendocrine carcinoma with gastrin-producing cell differentiation (Figure 4), and the liver sample was diagnosed as chronic cholangiohepatitis.