[Nasobiliary drainage for spontaneous bile peritonitis due to cholangiocarcinoma]

We report a case of cholangiocarcinoma presented with bile peritonitis, in which endoscopic nasobiliary drainage (ENBD) as well as pleural and abdominal drainages improved the general condition leading to a radical operation. The case was a 79-year-old woman with the chief complaints of fever and right hypochondralgia due to pleural effusion and infected ascites contaminated with bile including E. coli. However gall-stones were not recognized in any biliary trees. US-guided drainage was performed into the pleural and abdominal cavities because of poor condition. After continuous drainages, peritonitis was improved, but hematoemesis and tarry stool appeared. Emergent endoscopy revealed a multiple gastric ulcer, and the bleeding was stopped by an injection of ethanol. ERCP findings revealed a cholangiocarcinoma in superior and middle portion of the bile duct obstructed nearly completely. After improvement in general condition by ENBD, cholecystectomy, resection of extrahepatic bile duct and subtotal gastrectomy were performed followed the reconstruction with Roux-en-Y method. Postoperative course was uneventful and the patient was discharged at the postoperative 35th day. Thus, the appropriate and opportune multiple biliary drainages can save a patient with cholangiocarcinoma in poor condition and lead to tolerate the operation even if he or she is suffering from severe bile peritonitis.