| | | | | Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review | | | Radoje Colovic;Nikica Grubor;Rada Jesic;Marjan Micev;Tanja Jovanovic;Natasa Colovic;Henry Dushan Atkinson | | | 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.
【作者单位】：Institute for Digestive Diseases First Surgical Clinic;Clinical Center of Serbia;Institute for Digestive Diseases;First Surgical Clinic;Clinical Center of Serbia;Institute for Digestive Diseases;First Surgical Clinic;Clinical Center of Serbia;Institute for Digestive Diseases;First Surgical Clinic;Clinical Center of Serbia;Institute of Microbiology;Belgrade School of Medicine;Institute for Digestive Diseases;First Surgical Clinic;Clinical Center of Serbia;Imperial College School of Medicine;St Mary’s Hospital;Belgrade 11000;Serbia;Belgrade 11000;Serbia;Belgrade 11000;Serbia;Belgrade 11000;Serbia;Belgrade 11000;Serbia;Belgrade 11000;Serbia;Praed Street;London W2 1NY;United Kingdom
【分类号】：R575
【DOI】：CNKI:SUN:ZXXY.0.2008-19-027
【正文快照】：
INTRODUCTION Abdominal tuberculosis (ATB) is rare and obstructive jaundice caused by tuberculosis (TB) is extremely rare. ATB can mimic more common noninfectious abdominal syndromes and is often overlooked because of its low incidence. The mechanisms by w… | | |
| | |  推荐 CAJ下载  PDF下载 | | | CAJViewer7.0阅读器支持所有CNKI文件格式，AdobeReader仅支持PDF格式 | | | | Tuberculous lymphadenitis as a cause of obstructive jaundice:A case report and literature review | | | Radoje Colovic;Nikica Grubor;Rada Jesic;Marjan Micev;Tanja Jovanovic;Natasa Colovic;Henry Dushan Atkinson Institute for Digestive Diseases;First Surgical Clinic;Clinical Center of Serbia;Belgrade 11000;Serbia Tanja Jovanovic;Institute of Microbiology;Belgrade School of Medicine;Belgrade 11000;Serbia Imperial College School of Medicine;St Mary’s Hospital;Praed Street;London W2 1NY;United Kingdom | | | 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.
【Keyword】：Obstructive jaundice;Common bile duct stricture;Tuberculous lymphadenitis;Surgical excision;Roux en Y |
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