Abdominal Tuberculosis Leading to Prehepatic Portal Hypertension: A Case Report

Abstract

Tuberculosis can affect any organ or tissue in the abdomen such as gastrointestinal tract, peritoneum, lymphatic system and solid organs. Lymphadenopathy is the most common manifestation of abdominal tuberculosis which can be the only sign of the disease, especially in the periportal region or combined with peritoneal or solid organ involvement. There are a number of causes for prehepatic noncirrhotic portal hypertension, but there were a few reports of prehepatic portal hypertension associated with tuberculosis. Here we report a rare case of intra-abdominal tuberculosis as a cause for portal hypertension and recurrent gastrointestinal bleeding. Enlarged lymph nodes at hepatic hilum compressed the portal vein which caused portal hypertension and portal hypertensive gastropathy and enteropathy. The patient was managed by anti-tuberculosis therapy followed by splenectomy, surgical portaazygous devascularization and splenorenal shunt. In the 2-year followup after operation, the patient was free of symptoms and had cavernous portal vein transformation on CT, and disappearance of varices and portal hypertensive gastroenteropathy on EGDs.

Outcome of Abdominal Tuberculosis Complicated by Portal Hypertension, Pulmonary Tuberculosis, and Severe Acute Malnutrition

“…Two years post-surgery, patient was symptom-free, with CT showing transformation of the portal cavernous vein and esophagogastroduodenoscopy revealing the loss of varices and portal hypertensive gastroenteropathy. 13 This treatment could be an alternative choice for portal hypertension with esophageal varices in abdominal TB. However, its efficacy and safety in children still require further observation.…”