Korean J Gastrointest Endosc.  1997 Dec;17(6):821-826.

A Case of Duodenal Tuberculosis Which is Hardly Differentiated from Duodenal Lymphoma

• Kim WY
• Lee CH
• Kang JH
• Han SM
• So SC
• Kim JY
• Kim SE
• Imm EW
• Park SJ

Abstract

Primary duodenal tuberculosis, duodenal Crohn's disease, duodenal lymphoma, duodenal cancer is extremely rare event. Vague upper abdominal pain, weight loss(10 Kg) had been present for several months in a 52-yeer-old woman. Endoscopy revealed an irregular ulcer in the second part of the duodenum. CT of the abdomen revealed pooly defined hypodense and centrally low density masses along the hepatoduodenal ligament, with poor separation from the head of pancreas. Hypotonic duodenogram showed spiculation and smooth indentation of mucosal fold at medical aspect of sup. portion m descending duodenum. ERCP showed medially displaced distal CBD and main pancreaticduct. At first, lymphoma, cancer, Crohn's disease, duodenal tuberculosis were considered in the differential diagnosis. Endoscopic biopsy sepecimen of duodenal lesion showed atypical lymphocytes. We excluded the diagnosis of the duodenal cancer. We started anti-tubercular drugs because in our country tuberculosis is endemic. After 4 weeks anti-tuberculosis therapy, follow up endoscopy and biopsy specimens showed healing stage of duodenal ulcer and chronic granulomatous inflammation with multinucleated giant cell. Thus we concluded that when duodenal lesion which could not confirmed histopathologically it was wise to start antitubercular therapy than to perform exploraparotomic dianostic procedures.

Keyword

Duodenal tuberculosis; Duodenum; Tuberculosis

MeSH Terms

Abdomen
Abdominal Pain
Biopsy
Cholangiopancreatography, Endoscopic Retrograde
Crohn Disease
Diagnosis
Diagnosis, Differential
Duodenal Neoplasms
Duodenal Ulcer
Duodenum
Endoscopy
Female
Follow-Up Studies
Giant Cells
Head
Humans
Inflammation
Ligaments
Lymphocytes
Lymphoma*
Pancreas
Tuberculosis*
Ulcer