Abstract

Incidental gall bladder carcinoma (IGBC) is a condition where cholecystectomy performed for a benign disease like cholelithiasis and the specimen biopsy has evidence of carcinomatous lesion. We report a case of a 35-year-old female patient with a past history of laparoscopic cholecystectomy for symptomatic cholelithiasis presented to the surgical out-patient department with complains of a swelling beneath the scar in the epigastric region. Patient was evaluated with imaging studies and fine needle aspiration which had cells suggestive of a metastatic deposit at the epigastric site. Old hospital records from where the patient was treated was retrieved and a pathology of well differentiated adenocarcinoma of the gall bladder was noted, which the patient missed to follow up. The epigastric site was probably the specimen retrieval site and patient now have a metastatic deposit at that site. Discussion with the multidisciplinary team was carried out and a PET-CT scan was done and patient was started on gemcitabine and cisplatin. Patient had significant reduction in the size of the swelling. Port site metastasis can occur months to even years after the surgery and at many times be the initial presentation of a metastatic disease as in this case. The prevention and recognition of the metastatic deposit play a vital role in the management of such cases.

Key words: Cholelithiasis, Laparoscopic cholecystectomy, Port site metastasis, Unsuspected gall-bladder carcinoma