Abstract
THE PHANTOM OF THE PANCREAS: A CASE REPORT ON PANCREATIC TUBERCULOSIS MIMICKING PANCREATIC CARCINOMA
Karen Kaye A. Uy MD1, Princess Aurea L. Maderazo MD2, Rafael Chan MD1
1Section of Gastroenterology and Digestive Endoscopy, Department of Internal Medicine, Manila Doctors Hospital, 667 UN Avenue, Ermita, Manila, Philippines
2Department of Internal Medicine, Manila Doctors Hospital, 667 UN Avenue, Ermita, Manila, Philippines
Clinical Presentation: Pancreatic Tuberculosis is a rare disease even in regions of the world where the disease is highly prevalent. Its presenting symptoms are usually vague and non-specific, while the radiologic features can mimic pancreatic carcinoma. Due to its nature of presenting as a pancreatic mass, certain surgical interventions can become unwarranted, which may diminish the patient’s quality of life. This paper presents a case of 53-year-old male who presented with abdominal pain, fever and weight loss. The imaging studies revealed a pancreatic head and body mass causing moderate extrahepatic, intrahepatic and mild pancreatic ductal dilatation. There was also infiltration of the medial wall of the second part of the duodenum and postero-inferior wall of the first portion of the duodenum. On endoscopy, there was noted duodenal narrowing due to the mass encroaching the duodenum, hence malignancy was highly considered. The patient underwent Exploratory Laparotomy with Pancreatic Head Mass Biopsy which on frozen section revealed chronic granulomatous inflammation possibly tuberculous in etiology, hence proceeded only with Gastrojejunostomy and Cholecystojejunostomy. The patient was treated with anti-Koch’s medication for six months which resolved his symptoms and on repeat MRCP revealed pancreas is now normal, with resolution of previously seen mass involving the head and body; and there was no more evidence of biliary dilatation. Conservative management is usually successful in alleviating symptoms and even complete regression of mass lesions. The excellent response to Anti-Koch’s medication makes it imperative that these patients are diagnosed early and managed appropriately to avoid unwarranted surgery and associated morbidity.
Keywords: Pancreatic tuberculosis, pancreatic carcinoma
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
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