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Case Reports
. 2024 Mar 22;11(3):e01318.
doi: 10.14309/crj.0000000000001318. eCollection 2024 Mar.

Pancreatic Tuberculosis With Duodenal Fistula Presenting as Life-Threatening Gastrointestinal Bleeding

Duha Zaffar  1 , Chet Bahadur Ranabhat  1 , Abdellatif Ismail  1 , Gurdeep Gogna  2 , Sarah Hossain  2 , Gracia Viana Rodriguez  3 , Sharma Disha  3 , Kim Raymond  3
Affiliations
Case Reports

Pancreatic Tuberculosis With Duodenal Fistula Presenting as Life-Threatening Gastrointestinal Bleeding

Duha Zaffar et al. ACG Case Rep J. .

Abstract

Pancreatic tuberculosis (TB) warrants heightened suspicion in individuals with pancreatic lesions and risk factors such as HIV, organ transplantation, or pertinent immigration history. We present a 38-year-old man who presented with hemodynamically unstable gastrointestinal bleeding. He was found to have pancreatic TB complicated by a duodenal ulcer with fistula. Following 1 month of antitubercular therapy, he experienced complete resolution of symptoms, healing of the duodenal ulcer, closure of the fistulous tract, and a decrease in the size of the pancreatic lesion as observed on imaging. Our case highlights the importance of early diagnosis and treatment of pancreatic TB.

Keywords: duodenal fistula.; gastrointestinal bleeding; pancreatic tuberculosis.

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Figures

Figure 1.
Figure 1.
(A) Complex peripancreatic fluid collections largest 5.4 cm at the proximal body of the pancreas. (B) 4.8 cm complex peripancreatic fluid collection at the distal body and tail of the pancreas. (C) Dependent gas seen in peripancreatic fluid collection, suspicious for a fistula with adjacent bowel.
Figure 2.
Figure 2.
Upper endoscopy image showing a duodenal ulcer and a fistulous opening (yellow arrow) in the anterior duodenal sweep.
Figure 3.
Figure 3.
Microscopic view of acid fast bacilli grown from aspirated pancreatic collections. (600x).
Figure 4.
Figure 4.
EUS image showing aspiration needle (white line) in pancreas head cyst.
See this image and copyright information in PMC

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