title: Tuberculous lymphadenitis as a cause of obstructive jaundice: a case report and literature review.
abstract: Obstructive jaundice secondary to tuberculosis (TB) is extremely rare. It can be caused by TB enlargement of the head of the pancreas, TB lymphadenitis, TB stricture of the biliary tree, or a TB mass of the retroperitoneum. A 29-year-old man with no previous history of TB presented with abdominal pain, obstructive jaundice, malaise and weight loss. Ultrasonography (US), computer tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) were suggestive of a stenosis of the distal common bile duct (CBD) caused by a mass in the posterior head of the pancreas. Tumor markers, CEA and CA19-9 were within normal limits. At operation, an enlarged, centrally caseous lymph node of the posterior head of the pancreas was found, causing inflammatory stenosis and a fistula with the distal CBD. The lymph node was removed and the bile duct resected and anastomosed with the Roux-en Y jejunal limb. Histology and PCR based-assay confirmed tuberculous lymphadenitis. After an uneventful postoperative recovery, the patient was treated with anti-tuberculous medication and remained well 2.5 years later. Though obstructive jaundice secondary to tuberculous lymphadenitis is rare, abdominal TB should be considered as a differential diagnosis in immunocompromised patients and in TB endemic areas. Any stenosis or fistulation into the CBD should also be taken into consideration, and biliary bypass surgery be performed to both relieve jaundice and prevent further stricture.
authors.affiliation: Institute for Digestive Diseases, First Surgical Clinic, Clinical Center of Serbia, Koste Todorovica 6, Belgrade 11000, Serbia.
authors.forename: Radoje
authors.initials: R
authors.lastname: Colovic
authors.forename: Nikica
authors.initials: N
authors.lastname: Grubor
authors.forename: Rada
authors.initials: R
authors.lastname: Jesic
authors.forename: Marjan
authors.initials: M
authors.lastname: Micev
authors.forename: Tanja
authors.initials: T
authors.lastname: Jovanovic
authors.forename: Natasa
authors.initials: N
authors.lastname: Colovic
authors.forename: Henry-Dushan
authors.initials: HD
authors.lastname: Atkinson
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D013505:Digestive System Surgical Procedures; D006801:Humans; D041781:Jaundice, Obstructive / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy
chemical_list: D000995:Antitubercular Agents