Letter to the Editor Pancreatobiliary and peripancreatobiliary tuberculosis: a rare cause of obstructive jaundice

Abstract

Tuberculosis (TB) is one of the most common and well-described infectious diseases, with a worldwide distribution and a vast spectrum of clinical manifestations. Tuberculosis involvement of the bile duct, pancreatic, periportal and/or peripancreatic lymph nodes is, however, surprising rare [1]. Patients with TB of the bile duct, pancreatic, periportal and/or peripancreatic lymph nodes usually present with protracted illness and obstructive jaundice, which may be confused with cholangiocarcinoma or pancreatic malignancies. During a 13-year period we encountered 6 patients with TB of the bile duct, pancreatic, periportal and/or peripancreatic lymph nodes. We describe our experience with the management of this condition and emphasize the importance of a tissue diagnosis in all patients with obstructive jaundice to avoid missing this rare but curable disease, which can elude diagnosis and might prove to be potentially fatal if left untreated. Records of all patients with obstructive jaundice treated in the Department of General Surgery, Zhongshan Hospital, Medical School of Fudan University between January 1995 and January 2008 were retrieved and reviewed retrospectively, to find patients with a histologically proven diagnosis of TB of the bile duct, pancreatic, periportal and/or peripancreatic lymph nodes. Demographic details, presentation, clinic and radiologic findings, endoscopic and surgical treatment, complications, and follow-up were recorded. Written informed consent was obtained from all patients or patients’ relatives, and this study was approved by the local ethical committees. During the above-mentioned period, of a total of 1400 patients treated for various types of obstructive jaundice in our department, there were 6 (0.43%) patients with TB of the bile duct, pancreatic, periportal and/or peripancreatic lymph nodes. There were 4 males and 2 females with a mean age of 41.3 (range: 24– 54 years). These patients were symptomatic for a mean duration of 2 weeks (range 1 week to 4 weeks). The main presenting symptoms were: jaundice (n = 6); epigastric (upper abdominal) pain (n = 4); anorexia and weight loss (n = 3); fever (n = 4) (Table I). All patients were previously healthy and none gave a history of any recent or past contact with tuberculosis. Two patients had a history of alcohol abuse while one was a known diabetic. Chest radiographs were normal in 5 patients and one patient with pulmonary TB. Human immunodeficiency virus status was negative in all patients. The mean total serum bilirubin level was raised at 192 μmol/l (range: 89–253 μmol/l; normal: 2–24 μmol/l). The mean serum alkaline phosphatase, γ-glutamyl transpeptidase, and alanine transaminase levels Corresponding author: Dr Houbao Liu Zhongshan Hospital of Fudan University No. 180, Fenglinqiao Rd 200032 Shanghai, China Phone: +86-21-64041990 E-mail: drhoubao.liu@gmail.com Letter to the Editor