Hepatobiliary and pancreatic tuberculosis: A two decade experience

Abstract

BackgroundIsolated 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.MethodsThe 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.ResultsOf 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).ConclusionTuberculosis 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.

Sclerosing cholangitis-like changes in hepatobiliary tuberculosis

“…Recent reports have suggested the usefulness of the examination of the bile obtained during ERCP by cytology or PCR-based techniques for the demonstration of the bacilli (2,10). However, the diagnostic accuracy of these techniques has not been confirmed, and it is reported that only 1 of 5 pa-tients with biliary tuberculosis had positive cytologic results (1). The diagnosis was made by liver biopsy in our patient.…”

“…Men and women are affected equally and the symptoms are non-specific. The most common symptoms are reported to be abdominal pain, malaise, jaundice, anorexia, weight loss, and fever (1,7). In concordance with the literature, our patient had nonspecific symptoms such as malaise and itching.…”

“…Tuberculosis is one of the most prevalent infections in developing countries and its incidence has been rising in developed countries in the past couple of decades (1). The majority of cases have pulmonary tuberculosis, while biliary tuberculosis is extremely rare (2).…”

Pancreatic tubercular abscess in a patient of disseminated tuberculosis

“…USG abdomen can show presence of hypoechoic or cystic lesion as seen in our case. 12 On CECT pancreatic involvement typically appears as an enhancing hypodense mass, with irregular borders. 13 These findings are usually nonspecific, as cystadenocarcinomas, pancreatic adenocarcinomas and pancreatic pseudocysts have similar appearances.…”

“…11 While the presentation as pancreatic mass is seen in most of cases, pancreatic TB can also present as pancreatic abscess as in our case, acute or chronic pancreatitis, obstructive jaundice or portal vein thrombosis causing portal hypertension. 12 Techniques used to diagnose TB of pancreas can be invasive or noninvasive. Ultrasonography (USG) or computed tomography (CT) are often first-line diagnostic modalities.…”