TY - JOUR
T1 - Massive Esophageal Variceal Bleeding as the Initial Presentation of Peripancreatic Tuberculoma with Portal Hypertension
AU - Chiu, Chih-Lung
AU - Peng, Yi-Jen
AU - Chang, Wei-Kuo
AU - Hsieh, Tsai-Yuan
AU - Chao, You-Chen
AU - Chu, Heng-Cheng
N1 - 被引用次數:1
Export Date: 22 March 2016
CODEN: CYZAF
通訊地址: Chu, H.-C.; Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan; 電子郵件: [email protected]
化學物質/CAS: ethambutol, 10054-05-4, 1070-11-7, 3577-94-4, 74-55-5; isoniazid, 54-85-3, 62229-51-0, 65979-32-0; pyrazinamide, 98-96-4; rifampicin, 13292-46-1
參考文獻: Levine, C., Primary macronodular hepatic tuberculosis: US and CT appearances (1990) Gastrointest Radiol, 15, pp. 307-309; Leder, R.A., Low, V.H., Tuberculosis of the abdomen (1995) Radiol Clin North Am, 33, pp. 691-705; Xia, F., Poon, R.T., Wang, S.G., Bie, P., Huang, X.Q., Dong, J.H., Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China (2003) World J Gastroenterol, 9, pp. 1361-1364; Woodfield, J.C., Windsor, J.A., Godfrey, C.C., Orr, D.A., Officer, N.M., Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review (2004) ANZ J Surg, 74, pp. 368-371; Winternitz, M.C., Tuberculosis of the spleen (1912) Arch Intern Med, 9, pp. 680-697; Piersimoni, C., De Sio, G., Petroni, S., Mycobacterium avium and multi-drug-resistant Mycobacterium tuberculosis disseminated mixed infection in a patient with acquired immunodeficiency syndrome (1995) Clin Microbiol Newsletter, 17, pp. 6-7; Bora, P., Gomber, S., Agarwal, V., Jain, M., Splenic tuberculosis presenting as hypersplenism (2001) Ann Trop Paediatr, 21, pp. 86-87; Galloway, J.R., Henderson, J.M., Management of variceal bleeding in patients with extrahepatic portal vein thrombosis (1990) Am J Surg, 160, pp. 122-127; Lundstedt, C., Nyman, R., Brismar, J., Hugosson, C., Kagevi, I., Imaging of tuberculosis. II. Abdominal manifestations in 112 patients (1996) Acta Radiol, 37, pp. 489-495; Marshall, J.B., Tuberculosis of the gastrointestinal tract and peritoneum (1993) Am J Gastroenterol, 88, pp. 989-999; Luca, A., Cirera, I., Garcia-Pagan, J.C., Hemodynamic effects of acute changes in intra-abdominal pressure in patients with cirrhosis (1993) Gastroenterology, 104, pp. 222-227; Toyonaga, A., Iwao, T., Portal-hypertensive gastropathy (1998) J Gastroenterol Hepatol, 13, pp. 865-877; Orloff, M.T., Orloff, M.S., Orloff, S.L., Treatment of bleeding from portal hypertensive gastropathy by portocaval shunt (1995) Hepatology, 21, pp. 1011-1017; Kapoor, V.K., Abdominal tuberculosis (1998) Postgrad Med J, 74, pp. 459-467; Liu, Q., He, Z., Bie, P., Solitary pancreatic tuberculous abscess mimicking pancreatic cystadenocarcinoma: a case report (2003) BMC Gastroenterol, 3, p. 1; Lee, C.W., Lee, Y.S., Cho, G.Y., Kim, J.Y., Min, Y.I., A case of extrahepatic portal hypertension caused by periportal tuberculous lymphadenitis (1994) J Korean Med Sci, 9, pp. 264-267
PY - 2009
Y1 - 2009
N2 - Intra-abdominal tuberculoma is a rare manifestation of extrapulmonary tuberculosis (TB). It is even rarer for this condition to present with massive esophageal variceal bleeding. There are a few reports of portal hypertension associated with tuberculosis. A 52-year-old man with a history of chronic hepatitis B and a 1-year history of pulmonary TB was seen with complaints of hematemesis and bloody stools. He was thrombocytopenic, and abdominal computed tomography (CT) revealed a peripancreatic mass with vascular encasement and splenomegaly. CT-guided biopsy identified the tumor as a tuberculoma. During treatment for TB with an antituberculous regimen, massive esophageal varices bleeding occurred and endoscopic variceal band ligation was performed. Recurrent bleeding subsequently necessitated an exploratory laparotomy. This unusual presentation of an intra-abdominal tuberculoma with vessel encasement with portal hypertension and splenomegaly required CT-guided biopsy for a definitive diagnosis. Surgical intervention may be required for a patient who has esophageal varices resulting from portal hypertension after standard therapy for TB. Periportal tuberculoma should be included in the differential diagnosis of pancreatic head tumor with periportal vessel encasement and portal hypertension, especially for patients without evidence of cirrhosis or with a history of pulmonary TB. © 2009 Buddhist Compassion Relief Tzu Chi Foundation.
AB - Intra-abdominal tuberculoma is a rare manifestation of extrapulmonary tuberculosis (TB). It is even rarer for this condition to present with massive esophageal variceal bleeding. There are a few reports of portal hypertension associated with tuberculosis. A 52-year-old man with a history of chronic hepatitis B and a 1-year history of pulmonary TB was seen with complaints of hematemesis and bloody stools. He was thrombocytopenic, and abdominal computed tomography (CT) revealed a peripancreatic mass with vascular encasement and splenomegaly. CT-guided biopsy identified the tumor as a tuberculoma. During treatment for TB with an antituberculous regimen, massive esophageal varices bleeding occurred and endoscopic variceal band ligation was performed. Recurrent bleeding subsequently necessitated an exploratory laparotomy. This unusual presentation of an intra-abdominal tuberculoma with vessel encasement with portal hypertension and splenomegaly required CT-guided biopsy for a definitive diagnosis. Surgical intervention may be required for a patient who has esophageal varices resulting from portal hypertension after standard therapy for TB. Periportal tuberculoma should be included in the differential diagnosis of pancreatic head tumor with periportal vessel encasement and portal hypertension, especially for patients without evidence of cirrhosis or with a history of pulmonary TB. © 2009 Buddhist Compassion Relief Tzu Chi Foundation.
KW - Abdominal tuberculoma
KW - Esophageal variceal bleeding
KW - Portal hypertension
KW - Pulmonary tuberculosis
KW - ethambutol
KW - isoniazid
KW - pyrazinamide
KW - rifampicin
KW - adult
KW - article
KW - case report
KW - clinical examination
KW - clinical feature
KW - computer assisted tomography
KW - echography
KW - endoscopic surgery
KW - esophagus varices bleeding
KW - extrapulmonary tuberculosis
KW - follow up
KW - hematemesis
KW - hematochezia
KW - hepatitis B
KW - human
KW - laboratory test
KW - laparotomy
KW - lung tuberculosis
KW - male
KW - Mycobacterium tuberculosis
KW - pancreas biopsy
KW - pancreas tuberculoma
KW - pancreas tumor
KW - portal hypertension
KW - portosystemic anastomosis
KW - splenectomy
KW - splenomegaly
KW - thrombocytopenia
KW - treatment outcome
KW - vein ligation
U2 - 10.1016/S1016-3190(09)60033-1
DO - 10.1016/S1016-3190(09)60033-1
M3 - Article
SN - 1016-3190
VL - 21
SP - 172
EP - 177
JO - Tzu Chi Medical Journal
JF - Tzu Chi Medical Journal
IS - 2
ER -