Early intraperitoneal dissemination after radical resection of unsuspected gallbladder carcinoma following laparoscopic cholecystectomy.

We describe a case of early intraperitoneal dissemination after a radical second operation following laparoscopic cholecystectomy for unsuspected locally advanced carcinoma of the gallbladder. A radical procedure including wedge resection of the gallbladder bed, resection of the extrahepatic bile ducts, and dissection of the regional nodes and interaortocaval nodes was performed 17 days after laparoscopic cholecystectomy in a 60-year-old woman. The final histologic examination revealed a moderately differentiated adenocarcinoma invading perimuscular connective tissue with one positive pericholedochal node (pT2, pN1, pM0). Despite the absence of intraperitoneal dissemination at reexploration, the patient had intraperitoneal dissemination 5 months after the second operation. Insidious intraperitoneal dissemination may decrease the survival rate of locally advanced carcinoma of the gallbladder after laparoscopic cholecystectomy compared with open cholecystectomy. Surgeons should search for unsuspected carcinoma of the gallbladder intraoperatively to avoid implantation metastasis.