[A case of biliary panperitonitis due to intrahepatic bile duct rupture with intrahepatic bile duct tumor].

An 87-year-old man visited his previous doctor because of jaundice, abdominal pain, and disturbance of consciousness. He was diagnosed with cholangitis and panperitonitis and was referred to our hospital. Emergency laparotomy revealed biliary peritonitis. However, the bile leak point was unclear. Two days after surgery, endoscopic retrograde cholangiopancreatography was performed and revealed hilar bile duct stenosis, slight dilation of the intrahepatic bile duct, and bile leakage from the peripheral left intrahepatic bile duct to the abdominal free space. Endoscopic nasobiliary drainage was performed, and bile leakage decreased. He was discharged from our hospital with improvement from jaundice and peritonitis. Intrahepatic bile duct rupture with neoplastic obstruction of the bile duct is extremely rare. To date, only two cases of intrahepatic bile duct rupture with intrahepatic cholangiocarcinoma have been published.

[Two cases of neuroendocrine carcinoma in the biliary system with long-term survival].

We report here two cases of neuroendocrine carcinoma which occurred in the biliary system. The prognosis of neuroendocrine carcinoma in the biliary system is generally poor. However, based on the preoperative pathological diagnosis of neuroendocrine carcinoma, multidisciplinary treatment consisting of preoperative chemotherapy, chemoradiation therapy, curative resection and adjuvant chemotherapy seemed to be very effective and long-term survival was obtained in our two cases. Therefore it is essential to diagnose preoperatively to improve prognosis.