Tuberculous lymphadenitis as a cause of obstructive jaundice: A case report and literature review

被引:21
|
作者
Colovic, Radoje [1 ]
Grubor, Nikica [1 ]
Jesic, Rada [1 ]
Micev, Marjan [1 ]
Jovanovic, Tanja [3 ]
Colovic, Natasa [1 ]
Atkinson, Henry Dushan [2 ]
机构
[1] Clin Ctr Serbia, Surg Clin 1, Inst Digest Dis, Belgrade 11000, Serbia
[2] St Marys Hosp, Imperial Coll Sch Med, London W2 1NY, England
[3] Belgrade Sch Med, Inst Microbiol, Belgrade 11000, Serbia
关键词
obstructive jaundice; common bile duct stricture; tuberculous lymphadenitis; surgical excision; Roux en Y;
D O I
10.3748/wjg.14.3098
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture. (C) 2008 WJG. All rights reserved.
引用
收藏
页码:3098 / 3100
页数:3
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