Biliary Obstruction Due To Isolated Pancreatic Tuberculosis

A 38 -year-old male from Iraq without any history of previous infections presented at our institute with recently developed jaundice caused by a pancreatic head mass. A CT scan of the abdomen showed the mass in the pancreatic head without lymph node involvement or infiltration of the vascular structures (Image 1). ERCP revealed a double duct sign. Endoscopic stent placement adequately decompressed the common bile duct. At laparotomy, frozen section analysis of the lymph node samples (located at the hepatoduodenal ligament, diameter 1 cm, and the radix mesenterii, diameter 0.5 cm) showed no malignancy. A 4-cm mass was palpable in the pancreatic head and a pylorus -preserving pancreatic-duodenectomy was performed. Pathological examination of the specimen showed chronic pancreatitis caused by an extensive necrotizing granulomatous inflammation (Image 2); staining for acid fast bacilli were positive. The peripancreatic lymph nodes also showed typical caseating granulomas (Image 3). The patient was successfully treated with anti-tubercular therapy and is doing well. Isolated pancreatic tuberculosis is extremely rare (1) and is