title: [Implantation metastases following laparoscopic cholecystectomy in gallbladder carcinoma].
abstract: METHODS
  A 66-year-old woman was known to have had cholecystolithiasis for at least 4 years. Laparoscopic cholecystectomy was performed at another hospital where histological examination surprisingly revealed middle-grade differentiated carcinoma of the gall-bladder (pT2, G2). A nodular metastasis of the gall-bladder carcinoma was noted on the abdominal wall 3 months later and excised. Lymph-vessel carcinomatosis was already present. The patient again noticed a tumour in the right mid-abdomen and a further tumour was palpated in the epigastrium 5 months after the operation.
  
  
  METHODS
  Laboratory and tumour-marker (CEA, CA 19-9) tests were unremarkable, while sonography and computed tomography were highly suspicious for abdominal wall metastases in the epigastrium and right mid-abdomen.
  
  
  METHODS
  Both metastases were excised. Laparotomy revealed tumour recurrence in the old gall-bladder bed, as well as extensive peritoneal carcinoma. Two months after the operation she developed jaundice, caused by tumour compression of the choledochal duct. An expanding stent was inserted into the stenosed section of the duct. The patient died 13 months after the first operation from the underlying malignancy with multiple liver metastases and malignant ascites.
  
  
  CONCLUSIONS
  Indications for minimally invasive surgery in malignant tumour should be narrowly defined. Because tumour seeding is possible after laparoscopic cholecystectomy with incidentally found carcinoma extensive re-excision should be performed.
authors.affiliation: Klinik für Allgemein- und Thoraxchirurgie, Universität Giessen.
authors.forename: J
authors.initials: J
authors.lastname: Buhr
authors.forename: M
authors.initials: M
authors.lastname: Hürtgen
authors.forename: C M
authors.initials: CM
authors.lastname: Heinrichs
authors.forename: M
authors.initials: M
authors.lastname: Graf
authors.forename: W M
authors.initials: WM
authors.lastname: Padberg
mesh_terms: D000009:Abdominal Muscles / Q000473:pathology; D000008:Abdominal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D000273:Adipose Tissue / Q000473:pathology; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D009366:Neoplasm Seeding; D012086:Reoperation; D013997:Time Factors
vernacular_title: Implantationsmetastasen nach laparoskopischer Cholezystektomie bei Gallenblasenkarzinom.