Fig. 2

a Dynamic CT after 5 cycles of chemotherapy. Lymph node metastasis spread (maximum diameter, 120 mm) (arrow). The duodenum was strongly depressed, and air was observed in the tumor (short arrow). b The size of the intraductal tumor at B2 did not change after the patient received chemotherapy (arrow). c Abdominal CT revealed ascites and continuous free air inside the abdominal tumor as lymph node metastasis in the hepatoduodenal ligament (arrow). d Intraoperative macroscopic findings. The ruptured tumor was observed in the hepatoduodenal ligament (arrow)