Rare Presentation of Gall Bladder Tuberculosis in a Non Immuno-Compromised Patient

Abstract

The gall bladder is least common intra-abdominal organ to be involved by tuberculosis. It is either part of systemic miliary tuberculosis or abdominal tuberculosis. Isolated gall bladder tuberculosis is even rarer, can presents either as calculus or acalculus cholecystitis. Gall bladder tuberculosis presenting as a localized perforation with a sinus formation into anterior abdominal wall is unreported complication in a non immuno-compromised person. A 48-year old female presented with a gradually increasing swelling in right hypochondrium. Abdominal ultrasound showed superficial collection over right hypochondrium with intraperitoneal extension. Computed tomography showed localized gall bladder perforation with extension to the abdominal wall. Patient underwent emergency exploration and cholecystectomy with excision of sinus tract and drainage of abdominal wall abscess. Histopathological examination showed granulomatous cholecystitis suggestive of tuberculosis of gall bladder with extension into the sinus tract. She had an uneventful recovery and was treated with 6-month antitubercular therapy after surgery.

Keywords: Gall bladder tuberculosis; gall bladder perforation.

Figure 1.

Clinical photograph showing the abscess over right hypochondrium (white arrow).

Figure 2.

Contrast-enhanced computed tomography image showing the contracted gall bladder (arrowhead) with the subcutaneous collection (asterix).

Figure 3.

Intra-operative image showing the gall bladder area (black arrow) with the sinus tract in the anterior abdominal wall (white arrow).

Figure 4.

High power photomicrograph showing epitheloid cell granuloma, giant cells and surrounding lymphocytes (hematoxylin & eosin; 100X).

Figure 5.

Low power photomicrograph showing part of mucosal epithelium and presence of epitheloid cell granuloma in the serosa (hematoxylin & eosin; 100X).