A 74-year-old man presented with upper gastrointestinal bleeding. Investigation revealed a locally advanced intrahepatic cholangiocarcinoma (ICC) arose from left liver invading duodenum and diaphragm. Left trisectionectomy combined with wedge duodenal resection, left diaphragmatic and pericardial resection was performed. The diaphragmatic/pericardial defect was closed with Gore-Tex mesh. The patient developed post-operative intra-abdominal collection which resolved with percutaneous drainage. Pathology confirmed a 7 cm ICC, there was evidence of rupture with abscess formation, and adhesion but no direct invasion to duodenum and diaphragm. The resection margin was clear. The patient remained well for over 2 years after surgery when he was noted to have a new 2.3 cm left lower lobe lung lesion. Biopsy of lesion showed mucinous adenocarcinoma, which could be lung primary or metastatic ICC. The lung tumor was successfully treated with stereotactic body radiotherapy. He remained well afterwards and survived for ˃5 years without further recurrence since initial operation.
Keywords: diaphragm resection; intrahepatic cholangiocarcinoma; pericardiectomy.
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