Management challenges of ruptured adenosquamous carcinoma of the gallbladder

Gallbladder cancer is rare worldwide, and presentation is often very late with consequent dismal prognosis. We presented a 60-year-old woman with a history of recurrent right upper quadrant pain, weight loss, and abdominal mass 3 months before presentation. Preoperative diagnosis of gallbladder cholecystitis with hepatic abscess was made. At laparotomy, the gallbladder was ruptured, and an open fundus- first cholecystectomy was performed as well as adhesiolysis. Histological diagnosis of infiltrating adenosquamous carcinoma with Stage T3 disease was made. Postoperative computed tomography scan showed tumor infiltration of the gallbladder bed, stomach, and anterior abdominal wall. She had six courses of intravenous gemcitabine and oral capecitabine but was lost to follow-up 3 months after surgery. Late stage presentation and adenosquamous histological type conferred a poor prognosis on the patient. Radical surgery is typically advocated in such cases, but this has to be matched by standard anesthetic techniques to minimize morbidity and mortality.