Abstract
We present a case of benign biliary stricture caused by adenitis in the porta hepatis, which was determined tuberculous by diagnostic laparoscopic bioposy and subsequent histologic examiantion. A 22-year-old man, who was previously healthy and no history of suffering from disease, was admitted to our hospital because of general fatigue and jaundice. The laboratory findings revealed obstructive jaundice, and a stricture of the biliary tract was onfirmed by ERCP. Abdominal ultrasonogram and CT scan demonstrated enlarged lymph nodes in the porta hepatis. With a suspecion of malignant involvement, an exploratory laparoscopic biopsy was performed, and, then histologic examination revealed calcified granulomas consistent with tuberculous lymphadenitis. To our knowledge, only 9 cases of biliary stricture caused by tuberculous adenitis have been reported inJapan including our case. Radiographic differential diagnosis of tuberculous adenitis from malignant diseases have been reported to be difficult in the previous cases. They performed an invasive laparotomy to get the diagnosis of tuberculous adenitis. The use of laparoscopic procedure for histological diagnosis could avoid the problem of unnecessary invasive surgery and enable us to perform immediate therapy.
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