Obstructive pseudotumor of tuberculosis in a young woman: a rare presentation

Duodenal tuberculosis with gastric outlet obstruction: a case report of successful diagnosis and treatment, with review of literature

BACKGROUND

Duodenal tuberculosis (TB) is extremely rare, and its diagnosis is challenging owing to the lack of specific symptoms and radiological or endoscopic findings. When it leads to gastric outlet obstruction (GOO), diagnosing it accurately and providing appropriate treatment is crucial. However, this is often overlooked.

CASE PRESENTATION

A 35-year-old man presented with abdominal pain, fullness, vomiting, and weight loss. Upper gastrointestinal endoscopy and radiography revealed nearly pinpoint stenosis with edematous and reddish mucosa in the D1/D2 portion of the duodenum. Computed tomography (CT) showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph nodes, and portal vein stenosis. Conventional mucosal biopsy during endoscopy revealed ulcer scars. We initially suspected stenosis due to peptic ulcers; however, chest CT revealed cavitary lesions in both lung apices, suggesting tuberculosis. Due to the suspicion of duodenal TB and the need to obtain deeper tissue samples, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. The tissue sample showed caseating granulomas with multinucleated giant cells, and acid-fast bacilli were positive by Ziehl-Neelsen staining. The patient was diagnosed with duodenal TB and subsequent GOO. Because the patient had difficulty eating, surgical intervention was prioritized over antitubercular drugs, and laparoscopic gastrojejunostomy was performed. The patient started an oral diet on the 3rd postoperative day and began antitubercular treatment immediately after discharge on the 11th day. During the 6th month of treatment, endoscopic examination revealed residual duodenal stenosis; however, the bypass route functioned well, and the patient remained asymptomatic.

CONCLUSIONS

An aggressive biopsy should be performed to diagnose duodenal TB. EUS-FNA has proven to be a useful tool in this regard. Both nutritional improvement and antitubercular treatment were achieved early and reliably by performing laparoscopic gastrojejunostomy for duodenal TB with GOO.

Abdominopelvic Mass Revealing Tuberculosis in a Young Woman

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and remains a health problem, especially in developing countries. Abdominal location represents 5 to 10% of all locations. The clinical symptoms are not very specific, and the discovery of an abdominal mass in a context of deterioration of general state may wrongly lead to the diagnosis of a tumor. Radiological explorations remain sensitive in the detection of abdominal masses but they cannot prejudge their etiology. Surgical exploration is sometimes the only recourse either for diagnostic purposes or complications, and the diagnosis can only be confirmed by bacteriological and histological examinations of the surgical specimen. We report the case of abdominopelvic mass and lymph nodes revealing tuberculosis.