Umbilical metastasis after laparoscopic cholecystectomy

Abstract

Context: Laparoscopic cholecystectomy has been considered the surgical gold standard for gallbladder removal since its original description, and is performed worldwide. The incidental finding of gallbladder carcinoma during this procedure is a rare event, and preoperative diagnosis is difficult. Objective: This is a case report of metastasis in the umbilical cannula site of an unsuspected gallbladder carcinoma submitted to laparoscopic cholecystectomy. Case report: A 78-year-old male patient presented with a complaint of upper right quadrant abdominal pain, nausea, and vomiting of recent onset. There were no signs of jaundice, and liver function tests were normal. Abdominal ultrasound revealed a gallbladder with a thick wall and presence of multiple gallstones, with no indication of tumor. The patient underwent elective laparoscopic cholecystectomy using the four-trocar technique, and the surgery was uneventful. However, histological examination showed a well-differentiated tubular adenocarcinoma penetrating the full thickness of the gallbladder wall. Four months later, the patient presented periumbilical pain and a palpable semi-fixed clinically tumoral mass measuring 7 x 7 cm at the umbilicus. Patient was submitted to resection of the paraumbilical tumor, and diffuse peritoneal metastases were evidenced. The patient died seven moths after the laparoscopic cholecystectomy.