title: Biliary tract tuberculosis--a diagnostic dilemma.
abstract: BACKGROUND
  Most western patients who have not had a previous operation and present with biliary obstruction are thought to have a malignant lesion. However in our country where the disease is common, we found that some of these patients had a tuberculous cause which considerably altered their management as well as their prognosis. We herein present our experience of these patients whom we had operated with a preoperative diagnosis of biliary tract malignancy and discuss, retrospectively, how they might have been detected before operation to have tuberculosis.
  
  
  METHODS
  Between August 1996 and June 2010, we operated on 209 patients with a preoperative diagnosis of carcinoma of the gallbladder and common bile duct. Seven out of these 209 patients had biliary tuberculosis. We retrospectively analyzed the clinical features of these patients from our prospectively maintained database.
  
  
  RESULTS
  There were four males and three females who had a mean age of 54 (32-65) years. The bile duct was involved in four and gallbladder in three patients. In contrast to those with malignancy, patients with tuberculosis had a longer history (122 vs 44 days), an abdominal mass was present less frequently (28% vs 57%), the serum bilirubin was lower (1.6 vs 6 mg/dl), and they also had evidence of tuberculosis elsewhere in the body (28.5%). There was no operative mortality in biliary tract tuberculosis in contrast to 7.5% in biliary tract malignancy.
  
  
  CONCLUSIONS
  Though tuberculosis of the biliary tract is rare, it needs to be considered in the differential diagnosis of patients with biliary obstruction especially in countries where the disease is endemic.
authors.affiliation: Gyan Burman Liver Unit, Department of Surgical Gastroenterology and Liver Transplantation, Room no 3364, Third floor, Casualty Block, Sir Ganga Ram Hospital, New Delhi, 110060, India. drgmahu@rediffmail.com
authors.forename: Mahendran
authors.initials: M
authors.lastname: Govindasamy
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Srinivasan
authors.forename: Vibha
authors.initials: V
authors.lastname: Varma
authors.forename: Naimish
authors.initials: N
authors.lastname: Mehta
authors.forename: Amitabh
authors.initials: A
authors.lastname: Yadav
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumaran
authors.forename: Samiran
authors.initials: S
authors.lastname: Nundy
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery