Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2020; 12(3): 123-128
Published online Mar 27, 2020. doi: 10.4240/wjgs.v12.i3.123
Isolated gallbladder tuberculosis mimicking acute cholecystitis: A case report
Kai Siang Chan, Vishal G Shelat, Cher Heng Tan, Yee Lin Tang, Sameer P Junnarkar
Kai Siang Chan, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
Vishal G Shelat, Sameer P Junnarkar, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Cher Heng Tan, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Sameer P Junnarkar, Department of Pathology, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Chan KS wrote the paper; Shelat VG and Junnarkar SP performed the operation, supervised the study and designed the study; Tan CH and Tang YL provided advice and guidance on radiological and histopathological findings respectively.
Informed consent statement: Consent has been taken from the patient for publication of findings in a journal.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sameer P Junnarkar, FRCS (Gen Surg), MBBS, MD, Doctor, Surgeon, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. sp_junnarkar@ttsh.com.sg
Received: October 14, 2019
Peer-review started: October 14, 2019
First decision: November 6, 2019
Revised: November 20, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: March 27, 2020
Processing time: 136 Days and 17.5 Hours
Abstract
BACKGROUND

Isolated tuberculosis of the gallbladder is extremely rare due to its intrinsic resistance to tuberculous infections. There are reports of gallbladder tuberculosis mimicking cholecystitis or malignancy. However, these presentations were chronic. The diagnosis of gallbladder tuberculosis warrants the need for investigation of additional sites of inoculation and contact tracing of all tuberculosis contacts. Gallbladder tuberculosis is a rare entity but should be suspected in patients from endemic regions with risk factors such as underlying immunosuppression or history of tuberculosis.

CASE SUMMARY

We present a case of gallbladder tuberculosis presenting as acute cholecystitis. A 44-year-old Filipino lady presented with a 11-d history of right hypochondrium and epigastric pain which worsened after meals with no significant past medical history. She underwent laparoscopic cholecystectomy on the presumptive diagnosis of acute cholecystitis and diagnosed as gallbladder tuberculosis after histopathological examination. The patient did not have features of pulmonary or systemic tuberculosis nor was she immunocompromised. She recovered uneventfully. She was subsequently discharged and followed-up at a hospital in her home country due to financial and social reasons.

CONCLUSION

Clinicians should have a high index of suspicion for patients in endemic regions presenting with cholecystitis.

Keywords: Cholecystectomy; Cholecystitis; Gallbladder; Extra-pulmonary tuberculosis; Case report

Core tip: Isolated tuberculosis of the gallbladder is extremely rare due to its intrinsic resistance to tuberculous infections. We present a rare case of isolated gallbladder tuberculosis presenting as acute cholecystitis. Clinical examination revealed positive Murphy’s sign. The patient underwent laparoscopic cholecystectomy within the same admission. Histology shows necrotizing granulomatous inflammation with rare acid-fast bacilli which was identified on Ziehl-Neelsen stain. This case highlights the multivariable clinical presentations of gallbladder tuberculosis. Clinicians should have a high index of suspicion for patients in endemic regions presenting with cholecystitis to obtain a pre-operative diagnosis.