Hilar Tuberculous Lymphadenitis Presenting as Obstructive Jaundice in a Previously Cholecystectomized Patient: A Case Report

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Background: Tuberculosis involving abdominal lymph nodes is an uncommon but recognized cause of obstructive jaundice. Because its clinical and radiological presentation may mimic malignancy of the biliary tract or pancreatic head, diagnosis is often challenging.Case presentation: We report the case of a 40‑year‑old woman with a history of cholecystectomy performed four years earlier and followed for iron‑deficiency anemia. She was admitted with a 20‑day history of progressive cholestatic jaundice without digestive hemorrhage, associated with general deterioration. Clinical examination showed generalized mucocutaneous jaundice with stable hemodynamic status. Magnetic resonance cholangiography demonstrated a conglomerate of hilar and peri‑pancreatic lymphadenopathy causing dilation of intrahepatic and extrahepatic bile ducts. Thoracic CT was normal. Diagnostic laparoscopy revealed multiple lymph nodes at the hepatic hilum, the largest measuring 2 cm, with purulent content. Biopsy with intraoperative frozen section revealed non‑necrotizing tuberculoid granulomatous adenitis.Conclusion: Tuberculous lymphadenitis of the hepatic hilum is a rare but important differential diagnosis of obstructive jaundice. Surgical exploration with histological confirmation remains crucial when imaging findings mimic malignancy. Early diagnosis allows appropriate antituberculous treatment and avoids unnecessary extensive surgery.

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