Hepatobiliary tuberculosis: a 10 years retrospective study in Sarawak general hospital, Sarawak Malaysia

Abstract

Introduction: Tuberculosis (TB) is endemic in South East Asia and in Malaysia it is not an uncommon infective disease. In our country extra pulmonary tuberculosis represents 14% of overall cases. Hepatobiliary tuberculosis (HBTB) is one of the rare extrapulmonary (TB) manifestations. The complications can be devastating, hence the diagnosis and management of the disease is remarkably challenging. Method: Patients were identified by reviewing our Endoscopic Retrograde Cholangiopancreaticography (ERCP) registry and the hospital tuberculosis database. Thirty six patients were identified from 2008 till 2018 and the data was studied. Result: 36 patients were identified from 2008 until 2018. Majorities were aborigines staying in rural areas (75%). The patients’ age ranged from 24 to 77 years old (median age of 47 years old) . 23 patients had history of pulmonary TB (63.8%) while 13 had history of isolated HBTB (36.2%). The presentation was jaundice (76.9%), constitutional symptoms (59.8%), right hypochondrium pain (38.5%) and cholanigitis (25.9%). All patients had CT scan of the abdomen done. 18 patients who diagnosed with TB had positive involvement of liver and biliary system in CT scan. Sixteen was diagnosed through image-guided liver biopsy and two had open biopsy. All patients had ERCP done. 2 underwent Percutaneous Trans hepatic Biliary Drainage( PTBD) prior to ERCP. All patients took anti TB medication for at least 6 months. 1 patient passed away due to liver failure and 7 patients loss to follow up. Conclusion: HBTB is rare but it causes high morbidity. The diagnosis and management of the disease is challenging. Early identification of the disease and appropriate intervention might helps in reducing the complications of the disease.