Modified Sullivan-type segment III hepatojejunostomy for radiologically presumed unresectable hilar...

Hilar cholangiocarcinoma may present with advanced biliary obstruction requiring palliation. An 80-year-old frail woman with jaundice and severe pruritus had contrast-enhanced computed tomography findings radiologically consistent with Bismuth-Corlette type IV hilar cholangiocarcinoma. No tissue diagnosis was obtained. Cancer antigen 19-9, carcinoembryonic antigen, alkaline phosphatase, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography were unavailable at the treating hospital and were not performed. Because referral and non-operative biliary drainage were not feasible and the patient requested active symptom-directed treatment, a modified Sullivan-type segment III hepatojejunostomy was performed. Operative time was 85 min and blood loss 100 ml. Pruritus resolved and bilirubin decreased from 191.78 to 127.81 μmol/l by postoperative Day 10. The patient died ~2 months later from disease progression. The procedure therefore provided short-term symptomatic improvement and partial biochemical improvement only, illustrating a potential palliative option when standard drainage modalities are inaccessible.