Radical Cholecystectomy for GB Tuberculosis Mimicking GB Neck Carcinoma with Obstructive Jaundice

Abstract

Introduction: Isolated Hepatic-pancreato-biliary tuberculosis is a very rare condition and gall bladder tuberculosis is still rarer. Majority of patients with GB tuberculosis diagnosed in symptomatic gall stone disease, post cholecystectomy and only a few cases reported with GB neck involvement causing obstructing jaundice. We report a rate case of gall bladder tuberculosis presented as suspected GB neck carcinoma with obstructive jaundice. Methods: 55 year male presented with complaints of painful progressive jaundice since 2 month. H/o loss of appetite and significant loss of weight over last 2month. CECT abdomen and MRCP was s/o circumferential soft tissue thickening with high grade stenosis at gall bladder neck, CHD and superiorly extending upto confluence. EUS showed mass in GB neck extending to CHD around 2.5cm and EUS guided FNAC inconclusive. His total serum bilirubin was 6.9 and CA 19.9 was 271.9. Results: In view of ? carcinoma GB neck with obstructive jaundice he we underwent radical cholecystectomy with CBD excision. Intra operatively there is 3x3 cm mass present at GB neck and CHD reaching upto confluence. Post-operative period was grossly uneventful and patient was discharged on POD 7. Final histopathology was s/o Necrotizing granulomatous inflammation, consistent with tubercular cholecystitis. Proximal CHD also showing Necrotizing granulomatous inflammation. ZN stain shows an occasional bacilli. Following biopsy he was started on ATT and now at 6 months follow up he is totally asymptomatic. Conclusion: Gall bladder tuberculosis can present as carcinoma GB with obstructive jaundice and very difficult to diagnose preoperatively.