title: Hepatobiliary and pancreatic tuberculosis: a two decade experience.
abstract: BACKGROUND
  Isolated hepatobiliary or pancreatic tuberculosis (TB) is rare and preoperative diagnosis is difficult. We reviewed our experience over a period two decades with this rare site of abdominal tuberculosis.
  
  
  METHODS
  The records of 18 patients with proven histological diagnosis of hepatobiliary and pancreatic tuberculosis were reviewed retrospectively. The demographic features, sign and symptoms, imaging, cytology/histopathology, procedures performed, outcome and follow up data were obtained from the departmental records. The diagnosis of tuberculosis was based on granuloma with caseation necrosis on histopathology or presence of acid fast bacilli.
  
  
  RESULTS
  Of 18 patients (11 men), 11 had hepatobiliary TB while 7 had pancreatic TB. Two-thirds of the patients were < 40 years (mean: 42 yrs; range 19-70 yrs). The duration of the symptoms varied between 2 weeks to 104 weeks (mean: 20 weeks). The most common symptom was pain in the abdomen (n = 13), followed by jaundice (n = 10), fever, anorexia and weight loss (n = 9). Five patients (28%) had associated extra-abdominal TB which helped in preoperative diagnosis in 3 patients. Imaging demonstrated extrahepatic bile duct obstruction in the patients with jaundice and in addition picked up liver, gallbladder and pancreatic masses with or without lymphadenopathy (peripancreatic/periportal). Preoperative diagnosis was made in 4 patients and the other 14 were diagnosed after surgery. Two patients developed significant postoperative complications (pancreaticojejunostomy leak 1 intraabdominal abscess 1) and 3 developed ATT induced hepatotoxicity. No patient died. The median follow up period was 12 months (9-96 months).
  
  
  CONCLUSIONS
  Tuberculosis should be considered as a differential diagnosis, particularly in young patients, with atypical signs and symptoms coming from areas where tuberculosis is endemic and preoperative tissue and/or cytological diagnosis should be attempted before labeling them as hepatobiliary and pancreatic malignancy.
authors.affiliation: Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India. sundeepsaluja@yahoo.co.in
authors.forename: Sundeep S
authors.initials: SS
authors.lastname: Saluja
authors.forename: Sukanta
authors.initials: S
authors.lastname: Ray
authors.forename: Sujoy
authors.initials: S
authors.lastname: Pal
authors.forename: Manu
authors.initials: M
authors.lastname: Kukeraja
authors.forename: Deep N
authors.initials: DN
authors.lastname: Srivastava
authors.forename: Peush
authors.initials: P
authors.lastname: Sahni
authors.forename: Tushar K
authors.initials: TK
authors.lastname: Chattopadhyay
mesh_terms: D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis / Q000601:surgery; D014386:Tuberculosis, Hepatic / Q000175:diagnosis / Q000601:surgery