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KMID : 0359019950150020285
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Korean Journal of Gastrointestinal Endoscopy
1995 Volume.15 No. 2 p.285 ~ p.294
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A Case of Intraabdominal Tuberculosis with Pancreatic Involvement Showing Interesting ERP Finding
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박재민
송시영/박승우/정재복/강진경/박인서/이우정/최윤정/박찬일
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Abstract
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Tuberculosis of the pancreas is a very rare disorder, little reported in the literture. Several theories of the pathogenesis of pancreatic tuberculosis have been proposed. Direct invasion of the pancreas by Mycobacterium tuberculosis is rare;
most
commonly the pancreas is spared even liver and spleen are severely involved by miliary dissemination. More common is the involvement of abdominal lymph nodes which, as caseating masses, subsequently invade the pancreas. Pancreatic tuberculosis is
a
treatable and preventable disease; however, major challenges remain I diagnosis. There have been several reports including the endoscopic retrograde pancreatographic(ERP) findings however, our case of panoreatic tuberculosis showed quite unusual
ERP
findings.
We report a 54-year old man suffering from chronic epigastric pain and weight loss who was diagnosed intraabdominal tuberculosis with pancreatic involvement. Abdominal ultrasonography showed ill-defined hypoechoic mass at pancreatic head,
peripancreatic
lymph nodes enlargement and intra- and extrahepatic bile ducts dilatations. Endoscopic retrograde pancreatogram showed blurring and irregularity of the second branch of pancreatic duct at head and the parenchymal abnormal pooling of the contrast
dye was
noted. Percutaneous transhepatic cholangiogram revealed the complete obstruction of the distal common bile duct. At explolaparotomy, massive necrosis and fibrous adhesions were noticed around the extrahepatic bile duct and pancreas head and
multiple
pericholedochal lymph nodes enlargement and several whitish-yellow nodules on the surface of the liver were noted. The extrahepatic bile duct was dilated and the common bile duct at the suprapancreatic portion was compressed by the lymph nodes
and
necroinflammatory tissues which invaded the pancreatic head posteriorly. The microscopic findings of the nodules on liver surface and lymph nodes revealed the typical findings of the tuberculosis.
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KEYWORD
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