Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 21, 2008; 14(19): 3098-3100
Published online May 21, 2008. doi: 10.3748/wjg.14.3098
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
Radoje Colovic, Nikica Grubor, Rada Jesic, Marjan Micev, Natasa Colovic, 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
Henry Dushan Atkinson, Imperial College School of Medicine, St Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom
Author contributions: Colovic R, Grubor N, Jesic R and Colovic N undertook the surgery and clinical care of the patient; Jovanovic T made PCR analysis; Micev M performed histopathological analysis; Colovic R, Atkinson HD, Grubor N and Colovic N wrote the paper.
Correspondence to: Nikica Grubor, MD, Institute for Digestive Diseases, First Surgical Clinic, Clinical Center of Serbia, Koste Todorovica 6, Belgrade 11000, Serbia. ngrubor@eunet.yu
Telephone: +381-11-3610715
Fax: +381-11-3615569
Received: January 3, 2008
Revised: March 24, 2008
Published online: May 21, 2008
Abstract

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.

Keywords: Obstructive jaundice; Common bile duct stricture; Tuberculous lymphadenitis; Surgical excision; Roux en Y