Familial Biliary Tract Carcinoma

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To the Editor:— This letter documents the familial occurrence of biliary tract carcinoma in two Choctaw Indian brothers, both of whom were treated during my twoyear tour of duty at the US Public Health Service Indian Hospital, Talihina, Okla. I performed an exploratory operation on the first brother on Jan 14, 1963, because of obstructive jaundice. Adenocarcinoma of the ampulla was found, but, because adequate supplies of blood, surgical assistance, and pathological consultation were unavailable, only simple T-tube drainage of the common duct was performed. Wound infection delayed pancreaticoduodenectomy until March 8, 1963. Complete recovery followed a postoperative course complicated by pancreatic and small-bowel fistulas. I operated on the second brother on Nov 29, 1963, after he experienced an episode of obstructive jaundice. Adenocarcinoma of the distal common duct was found and T-tube drainage of the common duct was performed. Pancreaticoduodenectomy was carried out on Dec 13, 1963, with minimal

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