Objective:

To report a rare case of gastric cancer associated with ectopic drainage of the accessory common bile duct (ACBD) into the stomach and discuss the surgical management strategies employed.

Approach:

• Case Report: A 48-year-old male presented with retrosternal pain and melena, diagnosed with gastric cancer. Surgical intervention included subtotal gastrectomy with Roux-en-Y gastrojejunostomy, D2 lymphadenectomy, jejunojejunal end-to-side anastomosis, and choledochojejunostomy.

Key Findings:

• The patient was diagnosed with signet ring cell carcinoma of the gastric antrum.
• Intraoperatively, the ACBD was misidentified as an accessory left hepatic artery and transected, leading to bile leakage.
• Postoperative pathology confirmed no lymph node metastasis and negative surgical margins.

Interpretation:

Accurate identification of the ACBD during surgery is critical to prevent complications.

Limitations:

• The rarity of the condition limits the generalizability of the findings.
• Preoperative imaging did not identify the ACBD, which may have influenced surgical planning.

Conclusion:

Accurate diagnosis and management of ACBD are crucial in surgical procedures to avoid complications.