Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2008 May 21;14(19):3098-100.
doi: 10.3748/wjg.14.3098.

Tuberculous lymphadenitis as a cause of obstructive jaundice: a case report and literature review

Radoje Colovic  1 , Nikica Grubor, Rada Jesic, Marjan Micev, Tanja Jovanovic, Natasa Colovic, Henry-Dushan Atkinson
Affiliations
Review

Tuberculous lymphadenitis as a cause of obstructive jaundice: a case report and literature review

Radoje Colovic et al. World J Gastroenterol. .

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Abdominal CT-scan showing a low density mass on the posterior aspect of the head of the pancreas with contrast enhancing solid rim (arrow).
Figure 2
Figure 2
A: ERCP with a normal pancreatogram; B: A smooth long severe narrowing of the distal common bile duct.
Figure 3
Figure 3
The resected part of the common bile duct with fistula on the posterior wall (arrow).
Figure 4
Figure 4
A: Extensive chronic granulomatous lymphadenitis (HE, × 13); B: Focal tuberculoid granuloma formation (HE, × 64).
See this image and copyright information in PMC

References

    1. Crowson MC, Perry M, Burden E. Tuberculosis of the pancreas: a rare cause of obstructive jaundice. Br J Surg. 1984;71:239. - PubMed
    1. Chen CH, Yang CC, Yeh YH, Yang JC, Chou DA. Pancreatic tuberculosis with obstructive jaundice--a case report. Am J Gastroenterol. 1999;94:2534–2536. - PubMed
    1. Shan YS, Sy ED, Lin PW. Surgical resection of isolated pancreatic tuberculosis presenting as obstructive jaundice. Pancreas. 2000;21:100–101. - PubMed
    1. Kouraklis G, Glinavou A, Karayiannakis A, Karatzas G. Primary tuberculosis of the pancreas mimicking a pancreatic tumor. Int J Pancreatol. 2001;29:151–153. - PubMed
    1. Singh B, Moodley J, Batitang S, Chetty R. Isolated pancreatic tuberculosis and obstructive jaundice. S Afr Med J. 2002;92:357–359. - PubMed

MeSH terms

Substances