Diagnosis and management of biliary obstruction due to periportal tuberculous adenitis

Biliary obstruction due to periportal tuberculous adenitis is a rare condition which is difficult to diagnose and treat. We describe two patients presenting with obstructive jaundice due to periportal tuberculous adenitis managed by two different approaches. In one patient the diagnosis was made after laparotomy and lymph node biopsy, and segment III biliary enteric bypass was performed with good relief of obstruction. In another patient the diagnosis was established by laparoscopy and the patient was successfully managed conservatively with percutaneous biliary drainage and antituberculous treatment. The different approaches of diagnosis and management of this rare condition are discussed.