Tuberculosis of the bile duct - A rare cause of obstructive jaundice

Tuberculosis of the bile duct is extremely rare. Patients with this conditi on usually present with a protracted illness and obstructive jaundice, whic h may be confused with hepatobiliary malignancies. A retrospective review o f hospital records of patients who presented with tuberculosis of the bile duct between January 1986 and December 1996 was undertaken, and data were o btained concerning clinical presentation, investigations, treatment, and fo llow-up. Four patients (one man and three women) with a mean age of 44.8 ye ars had tuberculosis of the bile duct. Diagnostic imaging techniques showed bile duct dilation in all four patients. Endoscopic retrograde cholangiopa ncreatography (ERCP) showed a stricture in the proximal common bile duct (C BD) in one patient, a stricture in the distal CBD in one patient, a strictu re in the common hepatic duct (CHD) in one patient, and multiple strictures in the CHD and left intrahepatic duct in one patient. Bile cytology and fi ne-needle aspiration identified correctly the diagnosis in each patient. Tw o patients underwent laparotomy with the initial suspicion of cholangiocarc inoma; the correct diagnosis was made based on frozen sections taken intrao peratively. One patient was treated with endoscopic stenting and three pati ents underwent laparotomy for bile duct obstruction. All patients received antituberculous therapy. There were no deaths; all patients remained health y at a mean follow-up of 36.5 months. It is important to obtain a tissue di agnosis in all patients with obstructive jaundice to avoid missing this rar e but curable disease. The treatment of tuberculosis of the bile duct invol ves relief of the bile duct obstruction and antituberculous therapy.