Complicated Klatskin IIIB tumor

Abstract

Hilar cholangiocarcinoma (Klatskin tumor) is a rare neoplasm of the biliary tree, with high surgical complexity and a prognosis dependent on tumor extent and vascular patency. We present the case of a 42-year-old woman with no prior medical history or history of smoking or alcohol use, who presented with a 10 kg weight loss over six months, jaundice, dark urine, pale stools, daily fever, and right upper quadrant pain. Biochemical studies showed an obstructive pattern and hypoalbuminemia. Ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed left biliary dilation and a lesion consistent with a subsegment II abscess, with a hilar tumor and patency of the contralateral vessels. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed obstruction at the biliary confluence, leading to a diagnosis of Bismuth-Corlette type IIIB cholangiocarcinoma. Laparotomy with cholecystectomy, dissection of the hepatic hilum, and resection of the tumorous bile duct were performed, completing a left hemihepatectomy. Biliary reconstruction was performed using a Roux-en-Y hepaticojejunostomy. The surgery was successful, preserving the contralateral vessels and allowing for curative resection. This case highlights the importance of multimodal evaluation (ultrasound, ERCP, MRCP) and planned surgical approach in complex hilar cholangiocarcinomas.