A typical case easily overlooked Patient Question: Disease:Inferior bile duct jug tumor, bile duct obstruction Description:My father, 73 years old, was admitted to the hospital in early January this year with high fever, jaundice and other symptoms, after the fever subsided, a tumor in the inferior bile duct jug (suspected) was detected, and then bile was drained externally for about 1 month due to bile duct obstruction, because the old man was very weak, his family decided to take palliative care, so they tried to do bile duct stenting, but due to The bile duct obstruction failed yesterday for minimally invasive bile duct stenting. I would like to ask the doctor if there are any other possible treatment options to prolong the life of the old man and improve the quality of life for the rest of his life, instead of lying in the ward with a bile bag hanging outside his body like this. Hospital Department: Department of Hepatobiliary Medicine, The First People’s Hospital of Yunnan Province Medication: Name of medication: polyene-phosphatidylcholine, menadione urethane, etc. Description of medication: Before that, we have been using medication to remove jaundice, and after bile drainage, the old man could not eat for a while, so he was mainly maintained with nutritional fluids. Reply from Wang Wenquan, Department of Pancreatic, Hepatobiliary Surgery, Cancer Hospital of Fudan University: Hello, all the reports you provided are the examination reports, according to the local doctor’s diagnosis, it should be carcinoma of the lower pot belly of the common bile duct. As the PTCD has been successfully drained, I don’t know if the liver function has returned to normal, is the “poor health condition of the elderly” you mentioned a professional advice from the doctor? If the liver function is normal and the local doctor thinks it is feasible to operate, my suggestion is to remove it surgically as this is the only way to solve the problem completely and prolong the life of the old man. The next best option is ERCP to place a T-stent for internal drainage, or biliary-intestinal bypass, but this is not a permanent solution and there is still a risk of restenosis. The palliative treatment is liver preservation, but there is no other better treatment suggestion, and the effect of chemotherapy for bile duct cancer is not very good. Considering that the old man is only 73 years old and in poor physical condition, he can go back with drainage bag or stay in hospital for a period of time to recuperate, while continuing liver preservation treatment, and if the situation improves, surgery is still recommended. If he can get off the operating table, the prognosis is still quite good. The above suggestions are for reference. I wish you a speedy recovery!