Massive Esophageal Variceal Bleeding as the Initial Presentation of Peripancreatic Tuberculoma with Portal Hypertension

Chih-Lung Chiu, Yi-Jen Peng, Wei-Kuo Chang, Tsai-Yuan Hsieh, You-Chen Chao, Heng-Cheng Chu

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)172-177
Number of pages6
JournalTzu Chi Medical Journal
Volume21
Issue number2
DOIs
Publication statusPublished - 2009
Externally publishedYes

Fingerprint

Tuberculoma
Portal Hypertension
Tuberculosis
Hemorrhage
Esophageal and Gastric Varices
Splenomegaly
Tomography
Pulmonary Tuberculosis
Biopsy
Hematemesis
Chronic Hepatitis B
Laparotomy
Ligation
Blood Vessels
Neoplasms
Differential Diagnosis
Fibrosis
Therapeutics

Keywords

  • Abdominal tuberculoma
  • Esophageal variceal bleeding
  • Portal hypertension
  • Pulmonary tuberculosis
  • ethambutol
  • isoniazid
  • pyrazinamide
  • rifampicin
  • adult
  • article
  • case report
  • clinical examination
  • clinical feature
  • computer assisted tomography
  • echography
  • endoscopic surgery
  • esophagus varices bleeding
  • extrapulmonary tuberculosis
  • follow up
  • hematemesis
  • hematochezia
  • hepatitis B
  • human
  • laboratory test
  • laparotomy
  • lung tuberculosis
  • male
  • Mycobacterium tuberculosis
  • pancreas biopsy
  • pancreas tuberculoma
  • pancreas tumor
  • portal hypertension
  • portosystemic anastomosis
  • splenectomy
  • splenomegaly
  • thrombocytopenia
  • treatment outcome
  • vein ligation

Cite this

Massive Esophageal Variceal Bleeding as the Initial Presentation of Peripancreatic Tuberculoma with Portal Hypertension. / Chiu, Chih-Lung; Peng, Yi-Jen; Chang, Wei-Kuo; Hsieh, Tsai-Yuan; Chao, You-Chen; Chu, Heng-Cheng.

In: Tzu Chi Medical Journal, Vol. 21, No. 2, 2009, p. 172-177.

Research output: Contribution to journalArticle

Chiu, Chih-Lung ; Peng, Yi-Jen ; Chang, Wei-Kuo ; Hsieh, Tsai-Yuan ; Chao, You-Chen ; Chu, Heng-Cheng. / Massive Esophageal Variceal Bleeding as the Initial Presentation of Peripancreatic Tuberculoma with Portal Hypertension. In: Tzu Chi Medical Journal. 2009 ; Vol. 21, No. 2. pp. 172-177.
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abstract = "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. {\circledC} 2009 Buddhist Compassion Relief Tzu Chi Foundation.",
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author = "Chih-Lung Chiu and Yi-Jen Peng and Wei-Kuo Chang and Tsai-Yuan Hsieh and You-Chen Chao and Heng-Cheng Chu",
note = "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: chu5583@ms55.hinet.net 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",
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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: chu5583@ms55.hinet.net 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

VL - 21

SP - 172

EP - 177

JO - Tzu Chi Medical Journal

JF - Tzu Chi Medical Journal

SN - 1016-3190

IS - 2

ER -