Abstract
BACKGROUND: Adenocarcinoma is the most common malignant tumor of the bile duct, originating from the mucosal epithelium. Surgical resection is typically recommended for biliary adenocarcinoma to achieve the best therapeutic outcome and prognosis. However, early detection and diagnosis remain significant global challenges. CASE PRESENTATION: This paper presents a case of a 55-year-old female patient who was admitted to the Second People's Hospital of Nanning with complaints of dull pain in the right upper abdomen for 4 months and yellowing of the skin and sclera for the past half month. The patient was diagnosed as early well-differentiated biliary adenocarcinoma by probe-based confocal laser endomicroscopy (pCLE), biliary ultrasonography, choledochoscopy and biopsy. After pancreaticoduodenectomy, exploratory laparotomy, partial bowel resection, afferent loop and efferent loop anastomosis, the patient underwent surgery successfully. After 1 year of surgical treatment, no significant postoperative complications were found in the follow-up. There was no recurrence after operation and the patient made a full recovery. CONCLUSION: Bile duct adenocarcinoma is a malignant tumor, and early screening, diagnosis and treatment are crucial for improving patient prognosis. In this case, early cholangiocarcinoma was detected by a combination of choledochoscopy, biliary ultrasound, and biliary confocal endoscopy. The tumor and surrounding tissues were completely removed through pancreaticoduodenectomy. The operation was successful and the patient recovered well. Confocal microendoscopy shows great promise in the early diagnosis of digestive tract diseases, owing to its high-resolution imaging capabilities and potential to detect early lesions.