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Surgery for rare tumor of the gallbladder in MC Erebouni

Surgery for rare tumor of the gallbladder in MC Erebouni

 Surgery for  rare tumor of the gallbladder was carried out in General & Thoracic Surgery Department of MC Erebouni. For a period of several months the patient complained of increasing in abdominal volume, nausea, lack of appetite, general weakness, loss of weight.

The last time he had been examined 3 years ago, and was diagnosed with gallbladder disease.

Immediately after hospitalization, necessary laboratory and instrumental examinations were performed: abdominal ultrasound, CT-angiography, colonoscopy, EGD, transvaginal / transabdominal ultrasound.

CT scan revealed nonhomogeneous, with smooth edges tumor, size of 17x12x19 cm in the right region of abdominal cavity, fed by hepatic and cystic arteries starting from gallbladder area.

There were concrements in gallbladder cavity with size up to 16 mm, and small amount of   free fluid accumulation in pelvic region was detected.

Esophagogastroduodenoscopy test revealed that stomach cavity was increased, there was an antral fold due to an external pressure.

As with every case of tumor detection, this case has been discussed at the Tumor board as well, headed by the Deputy Director of oncology Dr Haykuhi Geokchyan. Surgical treatment was decided.

Rare surgery, median laparotomy was performed by surgical team of MC Erebouni Dr Andranik Ohanyan MD, Dr Artak Vardanyan PhD, clinical resident Hayk Aghabekyan and anesthesiologist Arthur Hovhannisyan MD under the supervision of Professor Hovhannes Sarukhanyan.

It was confirmed that all the right area of the abdomen was covered with solid, elastic consistency, uneven surface, irregular shape, size of about 20x25x20 cm tumor, which started from greatly increased gallbladder fundus by giving contact growth toward the liver tissue. It was situated between the greater omentum, not ingrowing into the upper and the widest part of large intestinal wall.

There was about 200 ml of clear fluid in abdomen.

Cholecystectomy was performed. Infected liver tissues adjacent to gallbladder fundus were also removed with tumor of the greater omentum and conglomerate with the use of LigaSure, drainage and sanitation of abdominal cavity was carried out as well. Histological examination of tumor revealed carcinosarcoma of gallbladder with metastasis to the greater omentum.

 

Head of Armenian-German Department of Pathology of MC Erebouni Professor Anna Khachatryan studied the tumor together with German collegues and found out that it was a rare type of tumor which is unique both in growth and in size, and was out of standards, moreover, it needs further medical examination.

Postoperative period was uneventful. The patient was discharged in good condition.

06.05.2019
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