Tuberculosis of the pancreas: A rare cause of massive gastrointestinal bleeding

Fan, ST; Yan, Kin-Wing; Lau, W. Y.; Wong, Kenneth K.

doi:10.1002/bjs.1800730517

Cited by 42 publications

(35 citation statements)

References 5 publications

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“…Fever was the most common symptom in a case series of 13 patients [13]. There are many case reports with different presentations of pancreatic tuberculosis like dyspeptic symptoms [14], gastrointestinal haemorrhage due to secondary to splenic vein thrombosis [15], acute/chronic pancreatitis [16], or secondary diabetes [17]. Pancreatic head masses may result in obstructive cholangiopathy and portal vein thrombosis.…”

Section: Clinical Presentationmentioning

confidence: 99%

Pancreatic Tuberculosis

2015

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Tuberculosis of the pancreas is extremely rare and in most of the cases mimics pancreatic carcinoma. There are a number of case reports on pancreatic tuberculosis with various different presentations, but only a few case series have been published, and most of our knowledge about this disease comes from individual case reports. Patients of pancreatic tuberculosis may remain asymptomatic initially and manifest as an abscess or a mass involving local lymph nodes and usually present with non-specific features. Pancreatic tuberculosis may present with a wide range of imaging findings. It is difficult to diagnose tuberculosis of pancreas on imaging studies as they may present with masses, cystic lesions or abscesses and mass lesions in most of the cases mimic pancreatic carcinoma. As it is a rare entity, it cannot be recommended but suggested that pancreatic tuberculosis should be considered in cases with a large space occupying lesions associated with necrotic peripancreatic lymph nodes and constitutional sympt o m s . U l t r a s o n o g r a p h y / c o m p u t e d t o m o g r a p h y / endosonography-guided biopsy is the recommended diagnostic technique. Most patients achieve complete cure with standard antituberculous therapy. The aims of this study are to review clinical presentation, diagnostic studies, and management of pancreatic tuberculosis and to present our experience of 5 cases of pancreatic tuberculosis.

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Section: Clinical Presentationmentioning

confidence: 99%

Pancreatic Tuberculosis

2015

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“…Pancreatic tuberculosis may present with a wide variety of manifestations, including fever, abdominal pain, anorexia, weight loss, obstructive jaundice, acute or chronic pancreatitis and gastrointestinal hemorrhage [3][4][5][6][9][10][11]. The nonspecific symptomatology and lack of clinical findings therefore, make the clinical diagnosis of pancreatic tuberculosis practically impossible.…”

Section: Discussionmentioning

confidence: 99%

Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Acar¹,

Sücüllü²,

Baylan³

et al. 2010

Open Medicine

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AbstractIsolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient’s occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient’s initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards.

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“…4,6,8,18,19,21,23,25,26 Gastrointestinal bleeding has also been reported and may occur because of formation of arterial pseudoaneurysms, portal hypertension, or duodenal mucosal involvement. 3,[28][29][30][31] Other complications include gastric outlet obstruction because of duodenal involvement, occurrence of sinistral portal hypertension, diabetes mellitus, abscess formation, and recurrent acute pancreatitis. [32][33][34][35] Presence of extra-pancreatic lesions especially pulmonary findings on chest roentgenogram may provide a clue to pancreatic involvement by tuberculosis.…”

Section: Clinical Presentation and Laboratory Findingsmentioning

confidence: 99%

“…The initiation phase of the therapy consists of intensive therapy with multiple drugs (rifampin, isoniazid, pyrazinamide, and ethambutol) given daily for 2 months, and this is followed by a continuation phase of at least 4 months with rifampin and isoniazid. The usual dosages for rifampin, isoniazid, pyrazinamide, and ethambutol are 10 mg/kg/day (8-12 mg/kg/day), 5 (4-6) mg/kg/day, 25 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) mg/kg/day, and 15 (15)(16)(17)(18)(19)(20) mg/kg/day respectively. In contrast to other forms of tuberculosis like pulmonary and intestinal, there is no data regarding use of intermittent therapy for pancreatic tuberculosis.…”

Section: Treatment Of Pancreatic Tuberculosismentioning

confidence: 99%

Pancreatic tuberculosis

Sharma

Rana

Kumar

et al. 2016

J of Gastro and Hepatol

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Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.

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Tuberculosis of the pancreas: A rare cause of massive gastrointestinal bleeding

Abstract: Case reportsintermingled with normal pancreatic acini. Tubercle follicles were also seen in the rest of the pancreas. The serosal surface of the stomach was also coated with tuberculous nodules. Multiple tuberculous nodules were seen in the lungs.

Cited by 42 publications

References 5 publications

Pancreatic Tuberculosis

Pancreatic Tuberculosis

Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Pancreatic tuberculosis

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