OVERVIEW
Gallbladder tuberculosis is a specific inflammation of the gallbladder caused by Mycobacterium tuberculosis, often accompanied by gallbladder stones, and is a type of extrapulmonary tuberculosis. It is clinically rare, with a high incidence in middle age, and is more common in men than women. The disease has no specific clinical symptoms and is difficult to diagnose preoperatively.
Etiology
1. Mostly secondary to pulmonary tuberculosis and lymph node tuberculosis, tuberculosis bacilli spread to gallbladder through blood or lymph.
2. It can also be caused by direct invasion of tuberculosis lesions in neighboring organs.
3. Primary hepatic tuberculosis, tubercle bacilli travel to the gallbladder through the bile, causing gallbladder tuberculosis.
Symptoms
1. Clinical manifestations lack of specificity, and there are mostly symptoms of tuberculosis poisoning, such as fever, night sweats, malaise, lack of appetite, and so on.
2. Paroxysmal vague pain or colicky pain in the upper abdomen, accompanied by nausea and vomiting.
3. Abdominal mass, jaundice.
4. Slight right upper abdominal pressure, rebound pain, positive Murphy’s sign.
Examination
1. Laboratory examination
Increased white blood cell count, increased erythrocyte sedimentation rate (sedimentation rate).
2. Imaging
Ultrasound and CT examination may show nodular foci in the gallbladder wall or gallbladder mass with calcification, narrowing and stenosis of the gallbladder lumen and enlargement of the surrounding lymph nodes.
3. Tuberculin test
Tuberculin test is positive.
4. Pathologic examination
Typical caseous granulomas and positive staining for Mycobacterium avium are seen.
Diagnosis
1. Medical history
The patient has a history of tuberculosis.
2. Clinical manifestations
The presence of right upper abdominal pain, fever and night sweats can be considered.
3.Auxiliary examination
Most patients are difficult to be diagnosed before surgery, and need to be operated for histopathological examination of gallbladder to see typical caseous granuloma and positive staining of bacillus antacidus to confirm the diagnosis. A small number of non-operative and suspected gallbladder tuberculosis, through the puncture of tuberculosis nodule histopathological examination or percutaneous bile drainage bile culture to confirm the diagnosis.
Differential diagnosis
This disease needs to be differentiated from gallbladder stones, acute cholecystitis, chronic cholecystitis, gallbladder tumor and other diseases.
Treatment
1. Drug treatment
Application of anti-tuberculosis drugs.
2.Surgery
Perform cholecystectomy, remove the gallbladder and clean up the surrounding enlarged lymph nodes to avoid recurrence.