Pancreatic Tuberculosis. A Surprise for a Surgeon
Keywords:
Pancreas, Tuberculosis, Pancreatic abscess, Pancreatic pseudocyst, Fine-needle aspirationAbstract
Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma, metastatic carcinoma, cystic neoplasia, retroperitoneal tumors, pancreatic abscess, pancreatic pseudocyst or pancreatitis. In general the correct diagnosis is not established before surgery unless there are detectable foci of TB somewhere else or a relevant clinical history. Review of the clinical presentations, radiographic investigations, laboratory findings, criteria and clues for diagnosis as well as management of pancreatic TB were summarized to emphasize the significance of this rare disease in the differential diagnosis of a pancreatic mass and the necessity of pathological and microbiological diagnosis by fine-needle aspiration.
References
1. Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol 1977;67:324-37.
2. Hulnick DH, Megibow AJ, Naidich DP, Hilton S, Cho KC, Balthazar EJ. Abdominal tuberculosis: CT evaluation. Radiology 1985;157:199-204.
3. Song TJ, Lee SS, Park do H, et al. Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis. Gastrointest Endosc 2009;69:484-91.
4. Auerbach O. Acute Generalized Miliary Tuberculosis. Am J Pathol 1944;20:121-36.
5. Watanapa P, Vathanopas V. Tuberculous pancreatic abscess: a rare condition mimicking carcinoma. HPB Surg1992;5:209-11; discussion 12-3.
6. Meesiri S. Pancreatic tuberculosis: a case report and systematic review. World J Gastroenterol 2012;18:720-6.
7. Paraf A, Menager C, Texier J. [Tuberculosis of the pancreas and tuberculosis of the lymph nodes of the upper region of the abdomen]. Rev Med Chir Mal Foie 1966;41:101-26.
8. Evans JD, Hamanaka Y, Olliff SP, Neoptolemos JP. Tuberculosis of the pancreas presenting as metastatic pancreatic carcinoma. A case report and review of the literature. Dig Surg 2000;17:183-7.
9. Nagar AM, Raut AA, Morani AC, Sanghvi DA, Desai CS, Thapar VB. Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr 2009;33:136-41.
10. Woodfield JC, Windsor JA, Godfrey CC, Orr DA, Officer NM. Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review. ANZ J Surg 2004;74:368-71.
11. Franco-Paredes C, Leonard M, Jurado R, Blumberg HM, Smith RM. Tuberculosis of the pancreas: report of two cases and review of the literature. Am J Med Sci 2002;323:54-8.
12. Radin DR. Intraabdominal Mycobacterium tuberculosis vs Mycobacterium avium-intracellulare infections in patients with AIDS: distinction based on CT findings. AJR Am J Roentgenol 1991;156:487-91.
13. Echenique Elizondo M, Amondarain Arratibel J, ComptonCC, Warshaw AL. Tuberculosis of the pancreas. Surgery 2001;129:114-6.
14. Liu Q, He Z, Bie P. Solitary pancreatic tuberculous abscess mimicking prancreatic cystadenocarcinoma: a case report.BMC Gastroenterol 2003;3:1.
15. De Backer AI, Mortele KJ, Bomans P, De Keulenaer BL,Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol 2005;184:50-4.
16. Stock KP, Riemann JF, Stadler W, Rosch W. Tuberculosis of the pancreas. Endoscopy 1981;13:178-80.
17. Xia F, Poon RT, Wang SG, Bie P, Huang XQ, Dong JH. Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China.World J Gastroenterol 2003;9:1361-4.
18. Cho SB. Pancreatic tuberculosis presenting with pancreatic cystic tumor: a case report and review of the literature. Korean J Gastroenterol 2009;53:324-8.
19. Teo LL, Venkatesh SK, Ho KY. Clinics in diagnostic imaging (117). Singapore Med J 2007;48:687-92; quiz 92.
20. Zalev AH, Sacks JS, Warren RE. Pancreaticoduodenaltuberculosis simulating metastatic ovarian carcinoma. CanJ Gastroenterol 1997;11:41-3.
21. Brugge WR, Mueller PR, Misdraji J. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 8-2004. A 28-year-old man with abdominal pain, fever, and a mass in the region of the pancreas. N Engl J Med 2004;350:1131-8.
22. Schapiro RH, Maher MM, Misdraji J. Case records of the Massachusetts General Hospital. Case 3-2006. A 63-yearold woman with jaundice and a pancreatic mass. N Engl J Med 2006;354:398-406.
23. Saluja SS, Ray S, Pal S, et al. Hepatobiliary and pancreatic tuberculosis: a two decade experience. BMC Surg 2007;7:10.
24. Veerabadran P, Sasnur P, Subramanian S, Marappagounder S. Pancreatic tuberculosis-abdominal tuberculosis presenting as pancreatic abscesses and colonic perforation. World J Gastroenterol 2007;13:478-9.
25. David AW, Eapen A, Vyas FL, Joseph P, Sitaram V. Thepancreas and tuberculosis: a diagnostic challenge. Indian J Gastroenterol 2008;27:29-30.
26. Chang WC, Chu HC, Tsai SH, Huang GS, Cheng MF, Yu CY. An extraordinary presentation. Am J Med 2009;122:245-7.
27. Jaber B, Gleckman R. Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review. Clin Infect Dis 1995;20:890-4.
28. Fernandez del Castillo C, Gonzalez-Ojeda A, Reyes E, Quiroz- Ferrari F, Uribe M, Robles-Diaz G. Tuberculosis of the pancreas. Pancreas 1990;5:693-6.
29. Rana SS, Bhasin DK, Srinivasan R, Sampath S, Mittal BR, Singh K. Distinctive endoscopic ultrasound features of isolated pancreatic tuberculosis and requirements for biliary stenting. Clin Gastroenterol Hepatol 2012;10:323-5.
30. Pombo F, Diaz Candamio MJ, Rodriguez E, Pombo S. Pancreatic tuberculosis: CT findings. Abdom Imaging 1998;23: 394-7.
31. Shih P MC, Chen CY, Wang CK, et al. MR and CT manifestations of pancreatic tuberculomas. Chin J Radiol 2001;26:33- 8.
32. Sanabe N, Ikematsu Y, Nishiwaki Y, et al. Pancreatic tuberculosis. J Hepatobiliary Pancreat Surg 2002;9:515-8.
33. Singh DK, Haider A, Tatke M, Kumar P, Mishra PK. Primary pancreatic tuberculosis masquerading as a pancreatic tumor leading to Whipple’s pancreaticoduodenectomy. A case report and review of the literature. JOP 2009;10:451-6.
34. Jenney AW, Pickles RW, Hellard ME, Spelman DW, Fuller AJ, Spicer WJ. Tuberculous pancreatic abscess in an HIVantibody-negative patient: case report and review. Scand J Infect Dis 1998;30:99-104.
35. Ladas SD, Vaidakis E, Lariou C, et al. Pancreatic tuberculosis in non-immunocompromised patients: reports of two cases, and a literature review. Eur J Gastroenterol Hepatol 1998; 10: 973-6.
36. Desai CS, Lala M, Joshi A, et al. Co-existence of periampullary carcinoma with peripancreatic tuberculous lymphadenopathy. JOP 2004;5:145-7.
2. Hulnick DH, Megibow AJ, Naidich DP, Hilton S, Cho KC, Balthazar EJ. Abdominal tuberculosis: CT evaluation. Radiology 1985;157:199-204.
3. Song TJ, Lee SS, Park do H, et al. Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis. Gastrointest Endosc 2009;69:484-91.
4. Auerbach O. Acute Generalized Miliary Tuberculosis. Am J Pathol 1944;20:121-36.
5. Watanapa P, Vathanopas V. Tuberculous pancreatic abscess: a rare condition mimicking carcinoma. HPB Surg1992;5:209-11; discussion 12-3.
6. Meesiri S. Pancreatic tuberculosis: a case report and systematic review. World J Gastroenterol 2012;18:720-6.
7. Paraf A, Menager C, Texier J. [Tuberculosis of the pancreas and tuberculosis of the lymph nodes of the upper region of the abdomen]. Rev Med Chir Mal Foie 1966;41:101-26.
8. Evans JD, Hamanaka Y, Olliff SP, Neoptolemos JP. Tuberculosis of the pancreas presenting as metastatic pancreatic carcinoma. A case report and review of the literature. Dig Surg 2000;17:183-7.
9. Nagar AM, Raut AA, Morani AC, Sanghvi DA, Desai CS, Thapar VB. Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr 2009;33:136-41.
10. Woodfield JC, Windsor JA, Godfrey CC, Orr DA, Officer NM. Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review. ANZ J Surg 2004;74:368-71.
11. Franco-Paredes C, Leonard M, Jurado R, Blumberg HM, Smith RM. Tuberculosis of the pancreas: report of two cases and review of the literature. Am J Med Sci 2002;323:54-8.
12. Radin DR. Intraabdominal Mycobacterium tuberculosis vs Mycobacterium avium-intracellulare infections in patients with AIDS: distinction based on CT findings. AJR Am J Roentgenol 1991;156:487-91.
13. Echenique Elizondo M, Amondarain Arratibel J, ComptonCC, Warshaw AL. Tuberculosis of the pancreas. Surgery 2001;129:114-6.
14. Liu Q, He Z, Bie P. Solitary pancreatic tuberculous abscess mimicking prancreatic cystadenocarcinoma: a case report.BMC Gastroenterol 2003;3:1.
15. De Backer AI, Mortele KJ, Bomans P, De Keulenaer BL,Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol 2005;184:50-4.
16. Stock KP, Riemann JF, Stadler W, Rosch W. Tuberculosis of the pancreas. Endoscopy 1981;13:178-80.
17. Xia F, Poon RT, Wang SG, Bie P, Huang XQ, Dong JH. Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China.World J Gastroenterol 2003;9:1361-4.
18. Cho SB. Pancreatic tuberculosis presenting with pancreatic cystic tumor: a case report and review of the literature. Korean J Gastroenterol 2009;53:324-8.
19. Teo LL, Venkatesh SK, Ho KY. Clinics in diagnostic imaging (117). Singapore Med J 2007;48:687-92; quiz 92.
20. Zalev AH, Sacks JS, Warren RE. Pancreaticoduodenaltuberculosis simulating metastatic ovarian carcinoma. CanJ Gastroenterol 1997;11:41-3.
21. Brugge WR, Mueller PR, Misdraji J. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 8-2004. A 28-year-old man with abdominal pain, fever, and a mass in the region of the pancreas. N Engl J Med 2004;350:1131-8.
22. Schapiro RH, Maher MM, Misdraji J. Case records of the Massachusetts General Hospital. Case 3-2006. A 63-yearold woman with jaundice and a pancreatic mass. N Engl J Med 2006;354:398-406.
23. Saluja SS, Ray S, Pal S, et al. Hepatobiliary and pancreatic tuberculosis: a two decade experience. BMC Surg 2007;7:10.
24. Veerabadran P, Sasnur P, Subramanian S, Marappagounder S. Pancreatic tuberculosis-abdominal tuberculosis presenting as pancreatic abscesses and colonic perforation. World J Gastroenterol 2007;13:478-9.
25. David AW, Eapen A, Vyas FL, Joseph P, Sitaram V. Thepancreas and tuberculosis: a diagnostic challenge. Indian J Gastroenterol 2008;27:29-30.
26. Chang WC, Chu HC, Tsai SH, Huang GS, Cheng MF, Yu CY. An extraordinary presentation. Am J Med 2009;122:245-7.
27. Jaber B, Gleckman R. Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review. Clin Infect Dis 1995;20:890-4.
28. Fernandez del Castillo C, Gonzalez-Ojeda A, Reyes E, Quiroz- Ferrari F, Uribe M, Robles-Diaz G. Tuberculosis of the pancreas. Pancreas 1990;5:693-6.
29. Rana SS, Bhasin DK, Srinivasan R, Sampath S, Mittal BR, Singh K. Distinctive endoscopic ultrasound features of isolated pancreatic tuberculosis and requirements for biliary stenting. Clin Gastroenterol Hepatol 2012;10:323-5.
30. Pombo F, Diaz Candamio MJ, Rodriguez E, Pombo S. Pancreatic tuberculosis: CT findings. Abdom Imaging 1998;23: 394-7.
31. Shih P MC, Chen CY, Wang CK, et al. MR and CT manifestations of pancreatic tuberculomas. Chin J Radiol 2001;26:33- 8.
32. Sanabe N, Ikematsu Y, Nishiwaki Y, et al. Pancreatic tuberculosis. J Hepatobiliary Pancreat Surg 2002;9:515-8.
33. Singh DK, Haider A, Tatke M, Kumar P, Mishra PK. Primary pancreatic tuberculosis masquerading as a pancreatic tumor leading to Whipple’s pancreaticoduodenectomy. A case report and review of the literature. JOP 2009;10:451-6.
34. Jenney AW, Pickles RW, Hellard ME, Spelman DW, Fuller AJ, Spicer WJ. Tuberculous pancreatic abscess in an HIVantibody-negative patient: case report and review. Scand J Infect Dis 1998;30:99-104.
35. Ladas SD, Vaidakis E, Lariou C, et al. Pancreatic tuberculosis in non-immunocompromised patients: reports of two cases, and a literature review. Eur J Gastroenterol Hepatol 1998; 10: 973-6.
36. Desai CS, Lala M, Joshi A, et al. Co-existence of periampullary carcinoma with peripancreatic tuberculous lymphadenopathy. JOP 2004;5:145-7.
Downloads
Published
2012-03-31
How to Cite
1.
Meesiri S, Apiwong S. Pancreatic Tuberculosis. A Surprise for a Surgeon. Thai J Surg [Internet]. 2012 Mar. 31 [cited 2024 Dec. 23];33(1):1-6. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/227764
Issue
Section
Review Articles
License
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.
