263 Tuberculosis of the Bile Duct: A Rare Cause of Obstructive Jaundice

Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. A 28-years old woman with obstructive jaundice, who was originally thought to have cholangio-carcinoma. Diagnosis of tuberculosis was made on PCR testing of bile. Patient was started on antitubercular treatment, and she responded well. This case presented a rare case of common bile duct stricture due to biliary tuberculosis. This is an important condition to diagnose because early recognition with prompt treatment results in complete resolution. Even though biliary tuberculosis is a rare cause of obstructive jaundice, in endemic areas, it should be considered as a differential diagnosis and investigated, as it can be potentially curable.

743 Inflammatory Pseudotumor (IPT) Of the Liver, A Diagnostic Dilemma with Therapeutic Uncertainty in A cohort of Bangladeshi patients (Observational Cohort Study)

Background

IPT a benign lesion seldom encountered in clinical practice. It’s mysterious in origin & remains ambiguous.Infection, stone,autoimmune disease,systemic inflammatory response,trauma,foreign body and neoplasm attributes to etiological factors.Advanced imaging modalities help in increased detection of focal liver lesion.

Aim

Method

Retrospective observational cohort study.

Results

14 male & 19 female were studied, mostly in 3rd decade of life. Clinically only 21% of them presented with fever.In 24 patients the lesions were located in left lobe of liver.The operative procedures were: wedge resection in 3 patients,limited resection in 5 patients,Left Hepatectomy 7 patients,Left lateral hepatic segmentectomy in 17 patients, right hepatectomy in 2 patients & central hepatectomy in 1 patient. 8patients required bilioenteric anastomosis as additional procedure.Histopathological study revealed Tuberculosis in 7 patients(21.21%),fungal granuloma in 3 patients, foreign body granuloma in 3 patients, Ductal calculi with abscess in 9 patients and idiopathic in 7 patients.

Conclusions

IPT of liver represents a rare entity usually mistaken as malignant lesion.Despite the low prevalence, it often creates a diagnostic dilemma resulting into therapeutic uncertainty.

Evaluation & management of clinically labeled carcinoma head of the pancreas--a prospective study of 60 patients

Carcinoma head of the pancreas are assessed by clinical examination, imaging, Endoscopic Retrograde Cholangio Pancreatography (ERCP), Fine Needle Aspiration Cytology (FNAC) and finally by laparotomy. Nevertheless still there is a dilemma in labeling these patients as having inoperable cancer pancreas because operable lesions may be wrongly labeled as inoperable or benign lesion may be thought to be malignant. The aim of this study is to evaluate these patients who present with clinical features of inoperable carcinoma of pancreas and to assess their status of inoperability. Efforts were taken to explore the possibilities of curative resection. If found inoperable, then tissue or cytological sampling of the lesion and the alternative palliation therapy offered to them. Palliative surgery and respective analysis of data was done in 60 patients with clinically labeled carcinoma head of the pancreas. Laparotomy was done for--(i) Assessment of inoperability, (ii) tissue or cytological sampling and (iii) Bilioenteric and gastro enteric bypass. The tumor was considered to be inoperable by peroperative assessment & trial dissection when it invaded the surrounding vital structure. Histological confirmation was made by intraoperative core needle biopsy; shave biopsy, biopsy of hepatic and lymph node metastasis. Cytological sampling was done by transduodenal and intralesional FNAC. Hepaticojejunostomy or Cholecystojejunostomy, Gastrojejunostomy and enteroenterostomy were performed as palliative procedure in all patients. Chemical splanchinectomy was performed in 25 patients. Twenty patients were diagnosed to have carcinoma by Endoscopic biopsy. In remaining 40 patients, peroperative tissue biopsy and cytological sampling yielded pancreatic carcinoma in 16 (40.0%), chronic pancreatitis in 6 (15.0%), pancreatic tuberculosis in 5 (12.5%), pancreatic non Hodgkin's lymphoma in 3 (7.5%) and metastatic pancreatic cancer in 2 (5.0%). However, it failed to reveal any definitive diagnosis in 8 (20.0%) patients. These interesting findings changed the preoperative diagnosis and guided us to plan the surgical procedure for cancerous and non-cancerous patients accordingly.