Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2006; 12(30): 4914-4917
Published online Aug 14, 2006. doi: 10.3748/wjg.v12.i30.4914
Biliary tuberculosis causing cicatricial stenosis after oral anti-tuberculosis therapy
Tomohisa Iwai, Mitsuhiro Kida, Yoshiki Kida, Nobuaki Shikama, Akitaka Shibuya, Katsunori Saigenji
Tomohisa Iwai, Mitsuhiro Kida, Yoshiki Kida, Nobuaki Shikama, Akitaka Shibuya, Katsunori Saigenji, Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Tomohisa Iwai, MD, Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan. t-iwai@poppy.ocn.ne.jp
Telephone: +81-42-7489111 Fax: +81-42-7498690
Received: February 8, 2006
Revised: March 1, 2006
Accepted: March 10, 2006
Published online: August 14, 2006
Abstract

A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stricture of the common hepatic duct at the liver hilum. Histological examination of biopsies from the bile duct revealed epithelioid cell granulomas and caseous necrosis. Tubercle bacilli were then detected on polymerase chain reaction (PCR) testing of the bile, giving the diagnosis of biliary tuberculosis. Although microbiological cure was confirmed, the patient developed cicatricial stenosis of the hepatic duct. She underwent repeated treatments with endoscopic biliary drainage (EBD) tubes and percutaneous transhepatic biliary drainage (PTBD) tubes, and the stenosis was corrected after 6 years. We present a case of tuberculous biliary stricture, a condition that requires careful differentiation from the more common malignancies and needs long-term follow-up due to the risk of post-treatment cicatricial stenosis, although it is rare.

Keywords: Biliary tuberculosis; Obstructive jaundice; Cicatricial stenosis; Polymerase chain reaction