Letter to the Editor
Pancreatobiliary and peripancreatobiliary tuberculosis: a rare cause of obstructive jaundice
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Submission date: 2010-10-08
Final revision date: 2011-04-29
Acceptance date: 2011-07-03
Online publication date: 2013-12-26
Publication date: 2013-12-31
Arch Med Sci 2013;9(6):1152–1157
Objective: Patients with tuberculosis (TB) involvement of the bile duct, pancreatic, periportal and/or peripancreatic lymph nodes is, however, surprising rare, usually present with protected illness and obstructive jaundice, which may be confused with cholangiocarcinoma or pancreatic malignancies. Methods: A retrospective review of hospital records of all patients with obstructive jaundice between January 1995 and January 2008 was undertaken. Results: During a 13-year period, of a total of 1400 patients treated of various obstructive jaundice, there were 6(0.43%) patients (4 males and 2 females) with TB of the bile duct, pancreatic, periportal and/or peripancreatic lymph nodes, with a mean age of 41.3 (range 24–54 years). These patients were symptomatic for a mean duration of 2 weeks (range 1 week to 4 weeks). Chest radiographs were normal in 5 patients and one patient with pulmonary TB. All patients underwent abdominal ultrasonography (US) as the first investigation for obstructive jaundice or epigastric pain. The procedures done included hepatectomy, excision of quadrate lobe, and Roux-en-Y hepaticojejunostomy (n=1); Roux-en-Y choledochojejunostomy (n=2); Whipple’s pancreacticoduodenectomy (n=1); T-tube drainage with frozen section (n=1); and lymph node resection and frozen section (n=2). All patients received antitubercular therapy (ATT) postoperatively. The mean follow-up of all patients was 40 months (range, 3-72 months). All patients remained healthy with no evidence of jaundice. Conclusions: A high index of suspicion in patients with bile duct strictures presenting in obstructive jaundice should prompt vigorous attempts at obtaining a preoperative histological or bacteriological diagnosis.