This paper deals with hepatocholangiojejunostomy for a patient with anemnesis of total gas-trectomy, using ρ-loop for reconstruction after extrahepatic bile duct resection for diffuse bile duct carcinoma. Metachronous double cancer involving the stomach and bile duct is rare, especially meta-chronous triple cancer like in this case.
An 80-year-old woman, who had previous histories of undergoing total gastrectomy and splenectomy for gastric cancer followed by reconstruction by ρ double tract method, was seen at the hospital because of chest discomfort and slight fever. Careful examination showed stenosis in the middle bile duct, and cytological examination of bile showed adenocarcinoma. At the operation, a frozen section showed cancer cells diffusely infiltrated a long the bile duct, so we performed resection of the extrahepatic bile duct, caudate lobe of the liver, part of the pancreas head, hepatocholangiojejunostomy, and reconstruction of the pancreatic duct. In the case of re-operation after total gastrectomy, we must consider the reconstruction method used at the previous operation and then select a most appropriate method from among a variety of reconstruction methods.