Table of Contents    
Case Report
 
Isolated tuberculosis of the pancreas mimicking a pancreatic tumor with concomitant choledocholithiasis
Ramesh Wijaya1, Chee Hoe Koo2, Adrian Kah Heng Chiow3, Siong San Tan4, Su-Ming Tan5
1MBBS, MRCS (Edin), Department of General Surgery, Changi General Hospital, Singapore.
2MBBS, Department of General Surgery, Changi General Hospital, Singapore.
3MBBS (Melb), MRCS (Edin), MMed (Surgery), Department of General Surgery, Changi General Hospital, Singapore.
4MBBS, MMed (Surgery), FRCS (Edin), Department of General Surgery, Changi General Hospital, Singapore.
5MBBS, FRCS (Edin), FRCS (Glasg), MMed (Surgery), FAMS, Department of General Surgery, Changi General Hospital, Singapore.

Article ID: 100001IJHPDRW2014
doi:10.5348/ijhpd-2014-17-CR-4

Address correspondence to:
Ramesh Wijaya
Department of General Surgery
Changi General Hospital, 2 Simei Street 3
Singapore. 529889
Phone: +65 6850-3607
Fax: +65 6260-1709
Email: ramesh_wijaya@cgh.com.sg

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How to cite this article:
Wijaya R, Koo CH, Chiow AKH, Tan SS, Tan Su-Ming. Isolated tuberculosis of the pancreas mimicking a pancreatic tumor with concomitant choledocholithiasis. Int J Hepatobiliary Pancreat Dis 2014;4:26–31.


Abstract
Introduction: Isolated pancreatic tuberculosis is an extremely rare condition, especially in immunocompetent individuals. Its presenting features are vague and non-specific. In addition, its radiological features often mimic pancreatic malignancy. The diagnosis is often made after surgery with its resultant morbidity. Isolated pancreatic tuberculosis, therefore, poses a great diagnostic and management challenge.
Case Report: We describe the first case report of primary pancreatic tuberculosis mimicking a cystic tumor of the pancreas with concomitant choledocholithiasis in an immunocompetent young woman. She had no known exposure history or demonstrable extra-pancreatic involvement. Diagnosis of pancreatic tuberculosis was established by endoscopic ultrasound (EUS)-guided fine-needle aspiration cytology (FNAC) and she responded to anti-tuberculous chemotherapy. Endoscopic stenting of the biliary system was performed in view of concomitant choledocholithiasis. We propose definitive choledocholithiasis clearance and surgery for biliary stone disease after completion of the standard course of medical therapy for pancreatic tuberculosis.
Conclusion: We recommend that tuberculosis should be included in the differential diagnosis of a pancreatic mass, especially in a younger patient coming from an endemic region. With heightened awareness of the features of this disease and the utility of novel endoscopic invasive diagnostic and therapeutic tools like EUS-guided FNAC and endoscopic stenting, the role of diagnostic surgery and its associated morbidity can be avoided in a similar clinical situation.

Keywords: Pancreatic tuberculosis, Endoscopy, Fine-needle aspiration cytology, Choledocholithiasis


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Author Contributions
Ramesh Wijaya – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Chee Hoe Koo – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Adrian Chiow – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Siong San Tan – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Su-Ming Tan – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Ramesh Wijaya et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.