Six cases of pancreatobiliary and peripancreatobiliary tuberculosis

Abstract

Objective To determine the clinical, imaging and pathologic characteristics of pan-creatobiliary and peripanereatobiliary tuberculosis. Methods The clinical data of 6 patients (4 male, 2 female; mean age 41.3 yrs, range 24-54 yrs) with pancreatobiliary and peripancreatobiliary tuberculo-sis treated in Zhongshan Hospital of Fudan University were analyzed retrospectively. Main clinical presentations were abdominal pain, fever and jaundice. Chest X-rays revealed TB in only one patient. Imaging findings showed limited biliary stricture with dilation of the proximal bile duct and other ima-ging manifestations included peripancreatobiliary mass in peripancreatobiliary lymph nodes tuberculo-sis, mass in the head of pancreas with enlarged peripancreatic lymph nodes in pancreatic tuberculosis, abnormal soft tissues around bile duct and duodenum in bile duct tuberculosis. All the 6 cases were misdiagnosed as malignancies before laparotomy. Tuberculosis was confirmed by pathological examina-tion. Therapeutic approaches included bile duct drainage and anti-tubercular drugs for 6-12 months. Results All the 6 were followed up for 3 months to 12 years. No recurrence of tuberculosis was found in the pancreatobiliary and peripancreatobiliary region. Conclusion The manifestations of pancreato-biliary and peripancreatobiliary tuberculosis are mimicking with those of malignancies. The diagnosis of tuberculosis is usually not suspected prior to laparotomy. Tuberculosis should be considered as a differential diagnosis in younger patients with pancreaticobiliary and peripancreaticobiliary mass. Pan-creatobiliary and peripancreatobiliary tuberculosis can be effectively cured by effective bile duct drain-age and anti-tubercular drugs. Key words: Tuberculosis, pancreatobiliary; Pancreatobiliary neoplasm; Differential diagnosis