CASE REPORT TUBERCULOUS PANCREATIC ABSCESS: A RARE CONDITION MIMICKING CARCINOMA

On admission he was deeply jaundiced with no palpable abdominal mass. Investigation confirmed an obstructive jaundice with marked elevation in serum bilirubin (33.4 mg/dl, normal 0.2 1.0 mg/dl) and alkaline phosphatase (191.0 Bodansky unit/L, normal 1.5 4.0 unit/L). Serum albumin was 34 g/L and transaminase levels were slightly raised. Chest radiography showed a fibrotic lesion at the right apex suggestive of old pulmonary tuberculosis (despite a negative history). Sputum examinations for acid-fast bacilli were negative on three consecutive days. Abdominal ultrasonography showed a distended gallbladder with a dilated common bile duct (2.0 cm diameter) and intrahepatic ducts. No gallstones were seen, but the pancreas was obscured by gas in the stomach. Cholangiography was not obtained. At laparotomy a large, hard and irregular mass (circa 5 cm diameter) was found in the head of pancreas with dilatation of the biliary tree. There were a few small lymph nodes (0.5-1.0 cm in diameter) along the superior border of the pancreas and mesenteric root; frozen section revealed no evidence of malignancy. Carcinoma of the head of pancreas was diagnosed and because trial dissection was favourable