One potential risk of percutaneous transhepatic biliary drainage (PTBD) is tumor seeding along the catheter tract. A 72-year-old woman was referred to our hospital because of obstructive jaundice. Five weeks after inserting PTBD from the 7th right intercostal space, a pylorus-preserving pancreaticoduodenectomy was performed for the diagnosis of distal bile duct carcinoma. The patient was given a pathological diagnosis of stage I (T1 N0 M0) distal bile duct carcinoma. A tumor with rash on PTBD fistula was found and was removed 3 years after the first operation. Histological findings were compatible with bile duct carcinoma metastasis. An isolated lymph nodal mass of the right axilla was found by CT 4 years and 6 months after the first operation, and an excision biopsy was performed. Histological findings were compatible with bile duct carcinoma metastasis again. The patient underwent chemotherapy, but multiple lung metastases appeared 4 months later and she died 6 years after the first operation. We report on a case of PTBD fistula recurrence and right axillary lymph node recurrence after radical surgery for early distal bile duct carcinoma.
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