[Tuberculous pancreatic abscess: differential diagnosis and favorable response to medical treatment]. / Absceso tuberculoso pancreático: diagnóstico diferencial y respuesta favorable al tratamiento médico.

ABSTRACT

Pancreatic tuberculosis is rare and may present differential diagnostic problems, specially with cancer of the pancreas. An immunocompetent patient with a pancreatic tuberculous abscess whose clinical manifestations were epigastric pain and a toxic syndrome of one month of evolution is presented. A cystic mass was detected on computerized axial tomography in the tail of the pancreas suggestive of irresectable carcinoma because of vascular invasion with negative percutaneous cytologic puncture for malignant cells. The patient was surgically treated with no histologic confirmation of malignancy. A second laparotomy was performed at 6 months since spontaneous size reduction, external pancreatic fistula with miliary peritoneal dissemination and biopsy compatible with tuberculous granulomas was found. Staining for resistant acid-alcohol bacilli were always negative. Medical treatment achieved complete disappearance of the pancreatic tumor in one year.