Gallbladder carcinomas are the most common form of biliary tract malignancies with adenocarcinomas, by far the most common variant while adenosquamous (adenosquamous carcinoma of the gallbladder) or pure squamous cell carcinomas representing only 2%–10% of all gallbladder carcinomas. Despite being a minority, these tumours demonstrate aggressive behaviour resulting in delayed presentations with widespread local invasion. We report a case involving a woman in her 50s who was diagnosed on imaging with a suspected gallbladder malignancy in the community. She proceeded to have a laparoscopic extended cholecystectomy with a cuff of segment 4b and 5 liver resection and cystic node sampling revealing a T3N1 lesion which on further recommendation by the multidisciplinary team proceeded to have an open portal lymphadenectomy yielding another positive lymph node. This case report highlights the dilemmas encountered in the management of this rare histological subtype in the absence of well-defined treatment algorithm and evolving guidelines.

Primary small bowel lymphomas are a rare entity but with significant morbidity and a low five-year overall survival even after surgery. Its diagnosis is often delayed due to the lack of clear specific signs, unfamiliarity amongst clinicians, and the lack of screening tools. This often results in patients presenting with tumour-associated complications such as perforation, obstruction, or gastrointestinal bleeding which warrant urgent surgical intervention. We present the case of a patient presenting with a perforated small bowel lymphoma resulting in a large interloop extraluminal faecaloma causing subacute small bowel obstruction. He proceeded to have an emergency open right hemicolectomy and extended small bowel resection to facilitate gross resection of tumour which in conjunction with adjuvant systemic chemotherapy is considered current best practice to manage such neoplasms. Early referral to specialist centres and raising awareness of this rare entity will allow earlier recognition and therefore a more planned approach to the management of such pathology with fewer post-operative complications.