Skip to main content

Advertisement

Log in

Pancreatic Tuberculosis

  • REVIEW ARTICLE
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

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 symptoms. Ultrasonography/computed tomography/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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Sharma MP, Bhatia A (2004) Abdominal tuberculosis. Indian J Med Res 120:6371–6375

    Google Scholar 

  2. Auerbach O (1944) Acute generalized military tuberculosis. Am J Pathol 20:121–136

    PubMed Central  CAS  PubMed  Google Scholar 

  3. Paraf A, Menager C, Texier J (1966) La tuberculose du pancreas et la tuberculose des ganglions de l’etage superieur de l’abdomen. Rev Med Chir Mal Foie 41:101–126

    CAS  PubMed  Google Scholar 

  4. Park K (2011) Epidemiology of communicable diseases. Park’s textbook of preventive and social medicine, 21st ed. Bhanot Jabalpur 64–68

  5. Nagar AM, Raut AA, Morani AC et al (2009) Pancreatic tuberculosis: a clinical and imaging review of 32 cases. J Comput Assist Tomogr 33:136–141

    Article  PubMed  Google Scholar 

  6. Xia F, Poon RT, Wang SG et al (2003) Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China. World J Gastroenterol 9:1361–1364

    Article  PubMed Central  PubMed  Google Scholar 

  7. Chang J, Tadi K, Halpern M et al (2008) Pancreatic tuberculosis in a human immunodeficiency virus positive patient: a case report. World J Gastroenterol 14:939–940

    Article  Google Scholar 

  8. Kumar R, Kapoor D, Singh J et al (2003) Isolated tuberculosis of the pancreas: a report of two cases and review of the literature. Trop Gastroenterol 24:76–78

    PubMed  Google Scholar 

  9. Ladas SD, Vaidakis E, Lariou C et al (1998) Pancreatic tuberculosis in non-immunocompromised patients: reports of two cases, and a literature review. Eur J Gastroenterol Hepatol 10:973–976

    Article  CAS  PubMed  Google Scholar 

  10. Meesiri S (2012) Pancreatic tuberculosis with acquired immunodeficiency syndrome: a case report and systematic review. World J Gastroenterol 18:720–726

    Article  PubMed Central  PubMed  Google Scholar 

  11. Pandya G, Dixit R, Shelat V et al (2007) Obstructive jaundice: a manifestation of pancreatic tuberculosis. J Indian Med Assoc 105:133–136

    PubMed  Google Scholar 

  12. Raghavan P, Rajan D (2012) Isolated pancreatic tuberculosis mimicking malignancy in an immunocompetent host. Case Rep Med. doi:10.1155/2012/501246

    Google Scholar 

  13. Yan CQ, Guo JC, Zhao YP (2007) Diagnosis and management of isolated pancreatic tuberculosis; experience of 13 cases. Chin Med Sci J 22:152–155

    PubMed  Google Scholar 

  14. Pandita KK, Sarla, Dogra S (2009) Isolated pancreatic tuberculosis. Indian J Med Microbiol 27:259–260

    Article  CAS  PubMed  Google Scholar 

  15. Fan ST, Yan KW, Lau WY et al (1986) Tuberculosis of the pancreas: a rare cause of massive gastrointestinal bleeding. Br J Surg 73:373

    Article  CAS  PubMed  Google Scholar 

  16. Rushing JL, Hanna CJ, Selecky PA (1978) Pancreatitis as the presenting manifestation of military tuberculosis. West J Med 129:432–436

    PubMed Central  CAS  PubMed  Google Scholar 

  17. Patankar T, Prasad S, Laxminarayan R (1999) Diabetes mellitus: an uncommon manifestation of tuberculosis. J Assoc Physicians India 47:938–939

    CAS  PubMed  Google Scholar 

  18. Chandrasekhara KL, Iyer SK, Stanek AE et al (1985) Pancreatic tuberculosis mimicking carcinoma. Gastrointest Endosc 31:386–388

    Article  CAS  PubMed  Google Scholar 

  19. Wu CS, Wang SH, Kuo TT (1994) Pancreatic tuberculosis mimicking pancreatic head carcinoma: a case report and review of the literature. Infection 22:287–289

    Article  CAS  PubMed  Google Scholar 

  20. Rezeig MA, Fashir BM, Al-Suhaibani H et al (1998) Pancreatic tuberculosis mimicking pancreatic carcinoma: four case reports and review of literature. Dig Dis Sci 43:329–331

    Article  CAS  PubMed  Google Scholar 

  21. Kouraklis G, Glinavou A, Karayiannakis A et al (2001) Primary tuberculosis of the pancreas mimicking a pancreatic tumor. Int J Pancreatol 29:151–153

    Article  CAS  PubMed  Google Scholar 

  22. Weiss ES, Klein WM, Yeo CJ (2005) Peripancreatic tuberculosis mimicking pancreatic neoplasia. J Gastrointest Surg 9:254–262

    Article  PubMed  Google Scholar 

  23. Yavuz A, Bulus H, Aydin A et al (2012) Pancreatic tuberculosis mimicking inoperable pancreatic cancer. Turk J Gastroenterol 23:95–97

    PubMed  Google Scholar 

  24. Crowson MC, Perry M, Burden E (1983) Tuberculosis of the pancreas: a rare cause of obstructive jaundice. Br J Surg 71:239

    Article  Google Scholar 

  25. Chen CH, Yang CC, Yeh YH et al (1999) Pancreatic tuberculosis with obstructive jaundice—a case report. Am J Gastroenterol 94:2534–2536

    CAS  PubMed  Google Scholar 

  26. Ozkan F, Bulbuloglu E, Inci MF et al (2013) Isolated pancreatic tuberculosis mimicking malignancy and causing obstructive jaundice. J Gastointest Cancer 44:118–120

    Article  Google Scholar 

  27. Ruttenberg D, Graham S, Burns D et al (1991) Abdominal tuberculosis: a cause of portal vein thrombosis and portal hypertension. Dig Dis Sci 36:112–115

    Article  CAS  PubMed  Google Scholar 

  28. Li XH, Wang YL, Yao YM (1999) A case of local portal hypertension caused by pancreatic TB. Zhonghua Gandan Waike Zazhi 4:28

    Google Scholar 

  29. Schneider A, Von-Birgelen U, Duhrsen G et al (2002) Two cases of pancreatic tuberculosis in non-immunocompromised patients: a diagnostic challenge and a rare cause of portal hypertension. Pancreatology 2:69–73

    Article  PubMed  Google Scholar 

  30. Zalev AH, Sacks JS, Warren RE (1997) Pancreaticoduodenal tuberculosis simulating metastatic ovarian carcinoma. Can J Gastroenterol 11:41–43

    CAS  PubMed  Google Scholar 

  31. Evans JD, Hamanaka Y, Olliff SP et al (2000) Tuberculosis of the pancreas presenting as metastatic pancreatic carcinoma. Dig Surg 17:183–187

    Article  CAS  PubMed  Google Scholar 

  32. Veerabadran P, Sasnur P, Subramanain S et al (2007) Pancreatic tuberculosis- abdominal tuberculosis presenting as pancreatic abscess and colonic perforation. World J Gastroenterol 13:478–479

    Article  PubMed Central  PubMed  Google Scholar 

  33. Nakai Y, Tsujino T, Kawabe T et al (2007) Pancreatic tuberculosis with a pancreatobiliary fistula. Dig Dis Sci 52:1225–1228

    Article  PubMed  Google Scholar 

  34. Rana SS, Bhasin DK, Rao C et al (2010) Isolated pancreatic tuberculosis mimicking focal pancreatitis and causing segmental portal hypertension. JOP 11:393–395

    PubMed  Google Scholar 

  35. Hellara O, Noomene F, Toumi O (2012) A pseudotumoral presentation of pancreatic tuberculosis. J Visc Surg 149:e282–e283

    Article  CAS  PubMed  Google Scholar 

  36. Stambler JB, Klibaner MI, Bliss CM et al (1982) Tuberculous abscess of the pancreas. Gastroenterology 83:922–925

    CAS  PubMed  Google Scholar 

  37. De Miguel F, Beltran J, Sabas JA (1985) Tuberculous pancreatic abscess. Br J Surg 72:438

    Article  PubMed  Google Scholar 

  38. Aggarwal P, Wali JP, Jain R et al (1989) Tubercular abscess of the pancreas. Am J Gastroenterol 84:985–986

    CAS  PubMed  Google Scholar 

  39. Berson BD, Mendelson DS, Janus CL (1989) Tuberculous abscess of the pancreas in AIDS: CT findings. Mt Sinai J Med 56:297–299

    CAS  PubMed  Google Scholar 

  40. Tetzeli JP, Pisegna JR, Barkin JS (1989) Tuberculous pancreatic abscess as a manifestation of AIDS. Am J Gastroenterol 84:581–582

    CAS  PubMed  Google Scholar 

  41. Meinke AK (1989) Pancreatic tuberculous abscess. Conn Med 53:139–141

    CAS  PubMed  Google Scholar 

  42. Cho KC, Lucak SL, Delany HM et al (1990) CT appearance in tuberculous pancreatic abscess. J Comput Assist Tomogr 14:152–154

    Article  CAS  PubMed  Google Scholar 

  43. Cappell MS, Laveed M (1990) Pancreatic abscess due to Mycobacterial infection associated with the acquired immunodeficiency syndrome. J Clin Gastroenterol 12:423–429

    Article  CAS  PubMed  Google Scholar 

  44. Watanapa P, Vathanopas V (1992) Tuberculous pancreatic abscess: a rare condition mimicking carcinoma. HPB Surg 5:209–213

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Lupatkin H, Brau N, Flomenberg P et al (1992) Tuberculous abscesses in patients with AIDS. Clin Infect Dis 14:1040–1044

    Article  CAS  PubMed  Google Scholar 

  46. Levine R, Tenner S, Steinberg W et al (1992) Tuberculous abscess of the pancreas. Case report and review of the literature. Dig Dis Sci 37:1141–1144

    Article  CAS  PubMed  Google Scholar 

  47. Park AJ (1993) Pancreatic tubercular abscess. Pancreas 8:137–138

    Article  CAS  PubMed  Google Scholar 

  48. Jaber B, Gleckman R (1995) Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient with the human immunodeficiency virus: case report and review. Clin Infect Dis 20:890–894

    Article  CAS  PubMed  Google Scholar 

  49. Desmond NM, Kingdon E, Beale TJ et al (1995) Tuberculous pancreatic abscess: an unusual manifestation of HIV infection. J R Soc Med 88:109–110

    Google Scholar 

  50. Molina M, Ortega G, Redondo C et al (1997) Tuberculous abscess of the pancreas as initial manifestation of AIDS. Gastroenterol Hepatol 20:165–166

    CAS  PubMed  Google Scholar 

  51. Jenney AW, Pickles RW, Hellard ME et al (1998) Tuberculous pancreatic abscess in an HIV antibody-negative patient: case report and review. Scand J Infect Dis 30:99–104

    Article  CAS  PubMed  Google Scholar 

  52. Ayala HI, Martinez GM, Halabe CJ (1998) Tuberculous pancreatic abscess as initial manifestation of AIDS. Rev Gastroenterol Mex 63:220–223

    Google Scholar 

  53. Jena GP, Manoharan GR, Mbete DL et al (1999) Tuberculous pancreatic abscess in HIV-positive patient. A report of 3 cases and a review of the literature. S Afr J Surg 37:69–71

    CAS  PubMed  Google Scholar 

  54. Chaudhary A, Negi SS, Sachdev AK et al (2002) Pancreatic tuberculosis: still a histopathological diagnosis. Dig Surg 19:389–392

    Article  PubMed  Google Scholar 

  55. Mangla V, George J, Das P et al (2013) Tubercular pancreatic abscess: diagnostic dilemma and management. Trop Gastroenterol 34:178–180

    Article  PubMed  Google Scholar 

  56. Knowles KF, Saltman D, Robson HG et al (1990) Tuberculous pancreatitis. Tubercle 71:65–68

    Article  CAS  PubMed  Google Scholar 

  57. Saluja SS, Ray S, Pal S et al (2007) Hepatobiliary and pancreatic tuberculosis: a two decade experience. BMC Surg 7:10

    Article  PubMed Central  PubMed  Google Scholar 

  58. Woodfield JC, Windsor JA, Godfrey CC et al (2004) Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review. ANZ J Surg 74:368–371

    Article  PubMed  Google Scholar 

  59. De Backer AI, Mortele KJ, Bomans P et al (2005) Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol 184:50–54

    Article  PubMed  Google Scholar 

  60. Chatterji S, Schmid ML, Anderson K et al (2012) Tuberculosis and the pancreas: a diagnostic challenge solved by endoscopic ultrasound. A case series. J Gastrointest Liver Dis 21:105–107

    Google Scholar 

  61. Mallery JS, Centeno BA, Hahn P et al (2002) Pancreatic tissue samplingguided bu EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc 56:218–224

    Article  PubMed  Google Scholar 

  62. Song TJ, Lee SS, Park do H et al (2009) Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis. Gastrointest Endosc 69:484–491

    Article  PubMed  Google Scholar 

  63. Kaushik N, Schoedel K, McGrath K (2006) Isolated pancreatic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report. JOP 7:205–210

    PubMed  Google Scholar 

  64. D’Cruz S, Sachdev A, Kaur L et al (2003) Fine needle aspiration diagnosis of isolated pancreatic tuberculosis. A case report and review of literature. JOP 4:158–162

    PubMed  Google Scholar 

  65. Rong YF, Lou WH, Jin DY (2008) Pancreatic tuberculosis with splenic tuberculosis mimicking advanced pancreatic cancer with splenic metastases: a case report. Cases J 1:84

    Article  PubMed Central  PubMed  Google Scholar 

  66. Franco-Parades C, Leonard M, Jurado R et al (2002) Tuberculosis of the pancreas: report of two cases and review of the literature. Am J Med Sci 323:54–58

    Article  Google Scholar 

  67. Makeshkumar V, Madhavan R, Narayanan S (2014) Polymerase chain reaction targeting insertion sequence for the diagnosis of extrapulmonary tuberculosis. Indian J Med Res 139:161–166

    PubMed Central  CAS  PubMed  Google Scholar 

  68. Gan HT, Chen YQ, Ouyang Q et al (2002) Differentiation between intestinal tuberculosis and Crohn’s disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 97:1446–1451

    Article  PubMed  Google Scholar 

  69. Salahuddin A, Saif MW (2014) Pancreatic tuberculosis or autoimmune pancreatitis. Case Rep Med. doi:10.1155/2014/410142

    PubMed Central  PubMed  Google Scholar 

  70. Chaudhary P (2014) Hepatobiliary tuberculosis. Ann Gastroenterol 27:207–211

    PubMed Central  PubMed  Google Scholar 

  71. Kim JB, Lee SS, Kim SH et al (2014) Peripancreatic tuberculous lymphadenopathy can masquerade as pancreatic malignancy: a single centre experience. J Gastroenterol Hepatol 29:409–416

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

None

Funding

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Poras Chaudhary.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chaudhary, P., Bhadana, U. & Arora, M.P. Pancreatic Tuberculosis. Indian J Surg 77, 517–524 (2015). https://doi.org/10.1007/s12262-015-1318-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-015-1318-4

Keywords

Navigation