Perforated duodenal tuberculosis with pancreaticobiliary disruption requiring salvage pancreaticoduodenectomy: a case report

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Abstract Gastroduodenal tuberculosis is uncommon, and duodenal perforation is exceptional. A 25-year-old man from rural Tanzania presented with generalized peritonitis after prolonged epigastric symptoms, weight loss, night sweats, and household tuberculosis exposure. Emergency laparotomy showed destructive pyloroduodenal perforation with insufficient viable tissue for local repair; distal gastrectomy and Roux-en-Y gastrojejunostomy were performed. Persistent high-output pancreatic-type drainage and progressive jaundice prompted relaparotomy, which demonstrated pancreaticoduodenal destruction and loss of distal biliary continuity. A tailored salvage pancreaticoduodenectomy was required. Histology showed necrotizing granulomatous duodenitis extending into peripancreatic fat and gallbladder serosa while sparing pancreatic acini and gallbladder mucosa. Antituberculous treatment was started, and the patient was well at 3 months. Pancreaticoduodenectomy is not standard treatment for duodenal tuberculosis but may exceptionally be unavoidable when lesser procedures cannot restore source control and anatomical continuity.