Obstructive jaundice caused by an abdominal tuberculous mass lesion

Area of Science:

• Gastroenterology
• Infectious Diseases
• Radiology

Background:

• Abdominal tuberculosis is an uncommon manifestation of tuberculosis, accounting for 5% of global cases.
• It often presents with vague symptoms, mimicking biliary and pancreatic diseases.
• This case highlights a rare presentation of abdominal tuberculosis causing jaundice and biliary obstruction.

Purpose of the Study:

• To report a case of abdominal tuberculosis presenting as biliary obstruction.
• To emphasize the importance of considering abdominal tuberculosis in differential diagnoses.
• To illustrate the diagnostic process and successful treatment of this condition.

Main Methods:

• Computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) were used for imaging.
• Endoscopic ultrasound (EUS) guided biopsy of a duodenal mass.
• Histological examination and tuberculosis polymerase chain reaction (PCR) testing of the biopsy sample.

Main Results:

• Imaging revealed a retroperitoneal mass causing common bile duct dilatation.
• EUS identified an ulcerated duodenal mass.
• Histology confirmed necrotising granulomas, and PCR testing was positive for tuberculosis, confirming extrapulmonary abdominal tuberculosis.

Conclusions:

• Abdominal tuberculosis can present insidiously and mimic other pathologies.
• Prompt diagnosis through imaging, EUS, and molecular testing is crucial.
• Effective treatment with a standard 6-month anti-tuberculosis regimen led to complete resolution.