Tuberculous Lymphadenitis as a Cause of Obstructive Jaundice
L. Jeremic, M. Stojanovic, M. Radojkovic, A. Zlatic, N. Ignjatovic, S. JeremicClinical case, no. 5, 2013
Obstructive jaundice secondary to abdominal tuberculosis isextremely rare. We present a patient with jaundice secondary tocompression of the common bile duct by TB lymphadenitis. A49-year-old woman was admitted to our department for nausea,epigastric pain and jaundice. Abdominal ultrasonography andcomputer tomography scan were suggestive of stenosis of thedistal common bile duct caused by a retropancreatic mass. Atlaparotomy, an enlarged lymph node behind the head of thepancreas was found, causing compression and stenosis of thedistal parts of the choledochus. The lymph node frozen sectionanalysis showed epithelioid granuloma with caseous necrosis,strongly suggesting tuberculous origin. Choledochoduodenalanastomosis was performed. Definitive pathohistologicalexamination confirmed TB lymphadenitis. ATB should beconsidered as a potential cause of jaundice especially inimmunocompromised patients and endemic areas. Diagnosingabdominal tuberculosis can be a challenging task. No satisfactorydiagnostic gold standard is available so that in most casesthe diagnosis cannot be reached before exploratory laparotomy.Early detection enables successful conservative treatment andeliminates the necessity of surgery.
