Tuberculous lymphadenitis as a cause of obstructive jaundice

Journal of Gastrointestinal Surgery, 2011

Introduction Most western patients who have not had a previous operation and present with biliary obstruction are thought to have a malignant lesion. However in our country where the disease is common, we found that some of these patients had a tuberculous cause which considerably altered their management as well as their prognosis. We herein present our experience of these patients whom we had operated with a preoperative diagnosis of biliary tract malignancy and discuss, retrospectively, how they might have been detected before operation to have tuberculosis. Methods Between August 1996 and June 2010, we operated on 209 patients with a preoperative diagnosis of carcinoma of the gallbladder and common bile duct. Seven out of these 209 patients had biliary tuberculosis. We retrospectively analyzed the clinical features of these patients from our prospectively maintained database. Results There were four males and three females who had a mean age of 54 (32-65) years. The bile duct was involved in four and gallbladder in three patients. In contrast to those with malignancy, patients with tuberculosis had a longer history (122 vs 44 days), an abdominal mass was present less frequently (28% vs 57%), the serum bilirubin was lower (1.6 vs 6 mg/dl), and they also had evidence of tuberculosis elsewhere in the body (28.5%). There was no operative mortality in biliary tract tuberculosis in contrast to 7.5% in biliary tract malignancy. Conclusion Though tuberculosis of the biliary tract is rare, it needs to be considered in the differential diagnosis of patients with biliary obstruction especially in countries where the disease is endemic.

Digestive and Liver Disease, 2003

A case of abdominal tuberculosis with pancreatic involvement is described. A 27-year-old Italian male, with no known cause of immunodeficiency and with no evidence of pulmonary tuberculosis, was admitted to our division because of acute pancreatitis. Abdominal imaging revealed a large 'tumour-like' mass in the pancreas head compressing the distal choledochous, and multiple adenopathy. Histological examination of multiple specimens removed during explorative laparotomy revealed granulomas with giant cells, caseous necrosis, and positive Ziehl-Neelsen staining. Tissue culture was positive for Mycobacterium tuberculosis. Once specific medical treatment was started, the pancreatic damage completely resolved.

Gastrointestinal Endoscopy, 2002

Indian Journal of Medical Microbiology, 2009

Tuberculosis of the pancreas is a clinical rarity and mimics pancreatic carcinoma both clinically and r a d i o l o g i c a l l y. A 3 2 -y e a r-old Somali male patient presented with history of vague abdominal pain, weight loss, anorexia and jaundice. Radiological imaging showed gall stones, dilated common bile duct (CBD) and a hetrogenous pancreatic mass. Endoscopic retrograde cholangio pancreatography (ERCP) showed marked narrowing of the CBD with an impression of external compression. Cholecystectomy and Choledochoduodenostomy (CDD) were performed after frozen section histopathology revealed the mass to be tuberculosis. P reoperative diagnosis of pancreatic tuber c u l o s i s re q u i res a high index of suspicion and usually its diagnosis is established after surgical tre a t m e n t . T h e response to antituberculosis treatment is very effective.

Radiology Case Reports

Biliary involvement during abdominal tuberculosis is extremely uncommon and represents a challenging diagnosis that can easily be mistaken for a malignant etiology. We report the case of a 40 years old male who presented with anorexia, chronic abdominal pain, and progressive obstructive jaundice. Abdominal computed tomography demonstrated distal narrowing with wall thickening of the main biliary duct, along with enlarged lymph nodes and signs of portal hypertension. Abdominal magnetic resonance imaging showed a long distal biliary stricture, suggestive of malignancy, with dilated intrahepatic radicles. The diagnosis of cholangiocarcinoma was initially suggested. However, given his young age and other imaging findings, the patient underwent laparoscopic biopsy which revealed epithelioid cell granuloma with caseating necrosis consistent with tuberculous origin.

Singapore medical journal

Obstructive jaundice is common and in most cases due to stone diseases or malignancies. Malignancies are important causes and are often unresectable at the time of diagnosis. Similarly, it is also important to consider infective causes such as tuberculosis (TB), particularly in endemic areas or in patients with risk factors. Although rare, the possibilities for the coexistence of different pathologies need to be considered as the treatment required will be different. We report a 67-year-old man with unexpected findings of obstructive jaundice secondary to biliary TB and an early ampullary tumour.

World journal of gastroenterology : WJG, 2006

Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. We report a 56-year-old man presented with jaundice, weight loss and poor appetite. Initial work up showed the dilated biliary system secondary to distal common bile duct stricture. Investigations to define the etiology of this stricture showed inconclusive brush cytology with absent abdominal masses and lymph nodes but enlarged mediastinal lymph nodes. Biopsy from these lymph nodes showed a non-caseating epitheliod granuloma with negative acid fast bacilli (AFB) stain. The patient had a dramatic response to empirical anti-tuberculosis therapy. Six weeks later, culture from lymph nodes was positive for Mycobacterium tuberculosis. Three months later, follow-up cholangiogram showed complete resolution of the stricture with normalization of liver enzymes 6 mo after starting anti-tuberculosis therapy. Tre...

Hpb Surgery, 2000

Analysis of 5 patients with gallbladder tuberculosis who had open cholecystectomy and review of literature have shown that, although still rare it presents as a part of systemic miliary tuberculosis, abdominal tuberculosis, isolated gallbladder tuberculosis and as acalculus cholecystitis in anergic patients. There are no pathognomonic signs, the diagnosis depends on suspicion of tuberculosis, peroperative findings and histological examination.

Journal of Gastroenterology and Hepatology, 2001

BMC …, 2007

Background: Isolated hepatobiliary or pancreatic tuberculosis (TB) is rare and preoperative diagnosis is difficult. We reviewed our experience over a period two decades with this rare site of abdominal tuberculosis. Methods: The records of 18 patients with proven histological diagnosis of hepatobiliary and pancreatic tuberculosis were reviewed retrospectively. The demographic features, sign and symptoms, imaging, cytology/histopathology, procedures performed, outcome and follow up data were obtained from the departmental records. The diagnosis of tuberculosis was based on granuloma with caseation necrosis on histopathology or presence of acid fast bacilli. Results: Of 18 patients (11 men), 11 had hepatobiliary TB while 7 had pancreatic TB. Two-thirds of the patients were < 40 years (mean: 42 yrs; range 19-70 yrs). The duration of the symptoms varied between 2 weeks to 104 weeks (mean: 20 weeks). The most common symptom was pain in the abdomen (n = 13), followed by jaundice (n = 10), fever, anorexia and weight loss (n = 9). Five patients (28%) had associated extra-abdominal TB which helped in preoperative diagnosis in 3 patients. Imaging demonstrated extrahepatic bile duct obstruction in the patients with jaundice and in addition picked up liver, gallbladder and pancreatic masses with or without lymphadenopathy (peripancreatic/periportal). Preoperative diagnosis was made in 4 patients and the other 14 were diagnosed after surgery. Two patients developed significant postoperative complications (pancreaticojejunostomy leak [1] intraabdominal abscess [1]) and 3 developed ATT induced hepatotoxicity. No patient died. The median follow up period was 12 months (9-96 months). Conclusion: Tuberculosis should be considered as a differential diagnosis, particularly in young patients, with atypical signs and symptoms coming from areas where tuberculosis is endemic and preoperative tissue and/or cytological diagnosis should be attempted before labeling them as hepatobiliary and pancreatic malignancy.