Pancreatic Tuberculosis with Vascular Involvement and Peritoneal Dissemination in a Young Man

Abstract

Pancreatic tuberculosis (TB) is an extremely rare form of extrapulmonary tuberculosis even in endemic areas that masquerades as a mass or inflammation because of lack of typical clinical manifestations and radiologic features and therefore usually misdiagnosed as a pancreatic malignancy or pancreatitis. Here we present a 23-year-old young man with pancreatic tuberculosis mimicking pancreatic head carcinoma A man who suffered from upper abdominal pain and nausea for half a month was admitted to our hospital. Narrow band imaging (NBI) and gastroscopic imaging, together with endoscopic ultrasonography (EUS), revealed a duodenal bulb mucous prominences lesion. Computed tomography (CT) and magnetic resonance imaging (MRI) both suggested a pancreatic mass which resembled a pancreatic head tumor that had a higher risk of malignancy. The patient therefore accepted an exploratory laparotomy and pancreatoduodenectomy, Whipple operation. Biopsies of pancreas, duodenum, lymph nodes, omentum, and adipose tissues were all performed, revealing tuberculosis infection in pancreas, hepatic portal vein infiltration, and peritoneal dissemination. The patient was treated successfully after operation and recovered with standard anti-TB drugs for 6 months. Timely reporting of this rare case can help physicians improve their ability to identify several specific illnesses and diseases that share confusing signs or symptoms clinically and radiographically.

Isolated pancreatic tuberculosis presenting as obstructive jaundice

“…4 Gastrointestinal tract is forming 6th most predilection site for TB. 9 Isolated pancreatic TB is a rare condition even in countries with a high prevalence of TB. First case of isolated pancreatic TB was reported in 1944.…”

“…These include hematogenous spread in case of miliary TB and lymph nodes, such as celiac and other retroperitoneal lymph nodes. 9,12,13 Loss of exocrine function of pancreas, making it vulnerable to infections and ingestion of contaminated food with Mycobacterium tuberculosis are other possible routes. 9 A diverse spectrum of presentation can be seen in case of isolated pancreatic TB, making it a diagnostic challenge.…”

“…9,12,13 Loss of exocrine function of pancreas, making it vulnerable to infections and ingestion of contaminated food with Mycobacterium tuberculosis are other possible routes. 9 A diverse spectrum of presentation can be seen in case of isolated pancreatic TB, making it a diagnostic challenge. It can be presented in the form of abdominal pain, fever, night sweats, anorexia/weight loss, malaise to a mechanically obstructing lesion causing obstructive jaundice14 where it masquerades as pancreatic inflammatory conditions such as pancreatitis and cysts or even misdiagnosed as pancreatic neoplasm.…”

“…Same density of pancreatic mass and other abdominal viscera, presence of gas and fluid in abdominal cavity and gut peristalsis are some of the influencing factors. 9 On CECT abdomen, ringed enhancement masses with low densities and calcifications can be appreciated in case of pancreatic TB. 15 On T1-weighted fat suppressed magnetic resonance imaging (MRI), tubercular lesion appears hypointense.…”

Isolated pancreatic tuberculosis mimicking pancreatic cancer: Case report

“…of new techniques and powerful imaging tools that enable the collection of pancreatic specimens. Another significant factor that contributes to the occurrence of increased number of reported cases of pancreatic TB is the rise in the population of immunocompromised individuals (Zhu et al, 2017). Pancreatic TB frequently mimics an unresectable malignant tumour clinically and radiologically, making it challenging to diagnose.…”