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

Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis

A high incidence of tuberculosis (TB), especially in endemic countries, makes this infectious disease a concern. Abdominal TB contributes to 10% of extrapulmonary TB. Due to nonspecific clinical, radiological, and endoscopic findings, diagnosing abdominal TB continues to be a challenge. Hence, a precise diagnosis is needed. The diagnosis of gastrointestinal disease using endoscopic ultrasound (EUS) is often performed due to its high resolution and ability to provide a real‐time visual representation of the gastrointestinal tract and extramural structures. EUS‐guided fine‐needle aspiration (FNA) and fine‐needle biopsy (FNB) have helped diagnose TB as they offer an adequate specimen for cytology or histopathological examination. This method is considered safer, more effective, and more efficient. The capacity of EUS to diagnose abdominal TB based on the affected organs was examined via a literature search. We reviewed the role of EUS in diagnosing esophageal, gastric, pancreatic, peripancreatic, hepatosplenic, peritoneal, and intestinal TB. Generally, EUS aids in diagnosing abdominal TB. In some organs, it is superior to other diagnostic modalities. However, further examinations, such as cytology or histopathology and microbial, are still needed. We also studied the roles of EUS‐FNA and EUS‐FNB. EUS‐FNA has shown a high diagnostic yield in esophageal (94.3–100%), pancreatic and peripancreatic (76.2%), and intestinal TB (84.1%). As minimally invasive methods, EUS‐FNA and EUS‐FNB can successfully provide sufficient samples. EUS is a functional diagnostic modality for abdominal TB. EUS‐FNA and EUS‐FNB provide sufficient samples safely and efficiently for further cytology, histopathology, and microbial examinations.

Calcified peripancreatic lymph nodes in pancreatic and hepatic tuberculosis mimicking pancreatic malignancy: A case report and review of literature

RATIONALE

Tuberculosis remains a serious menace to the health of people. Isolated hepatic tuberculosis is rare and pancreatic tuberculosis is extremely rare. The preoperative diagnosis of pancreatic tuberculosis remains a great challenge.

PATIENT CONCERNS

A 58-year-old Asian woman was referred to our hospital for evaluation of low back pain for 4 years and abdominal pain for 1 month.

DIAGNOSES

Computed tomography (CT) of the abdomen showed a hypodense mass in the pancreatic head and neck with abundant calcifications, a hypodense lesion in the liver without calcification, peripancreatic lymphadenopathy, calcifications in some lymph nodes. CT-guided fine needle aspiration biopsy of the hepatic lesion was carried out and the cytological examination revealed hepatic tuberculosis.

INTERVENTIONS

The patient was treated with antituberculous therapy for 1 year.

OUTCOMES

Low back pain and abdominal pain disappeared 3 months after initial treatment and after 2 year of follow-up, the patient was asymptomatic.

LESSONS

Our data hint that calcifications in both pancreatic lesions and peripancreatic lymph nodes may suggest pancreatic tuberculosis rather than pancreatic malignancy.

[Pancreatic tuberculosis]

Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.