Unexpected isolated hepatic tuberculosis discovered during laparoscopic cholecystectomy: A case report


Shema Ayadi
Faouzia Fares
Ahlem Blel
Yosra Zaimi
Asma Mensi
Leila Mouelhi
Radhouane Debbeche


Isolated hepatic tuberculosis is a rare form of extrapulmonary tuberculosis. We report an exceptional case of a 51-year-old female patient complaining from right upper abdominal quadrant pain, who underwent laparoscopic surgery for millimetric gallbladder polyps. Preoperative ultrasound hepatic morphology and biochemical hepatic tests revealed no abnormalities. There were no clinical patterns for an active tuberculosis. During surgery time, scattered sub-centimeter whitish nodular lesions were discovered on the upper surface of the liver. Although gallbladder pathological examination did not reveal any significant abnormalities, per surgery hepatic biopsy indicated the presence of a giant cell granuloma with caseous necrosis highly suggestive of hepatic tuberculosis. Treatment by anti-bacillary drugs according to local standard protocol was conducted with favorable outcomes. Therefore, diagnosis of hepatic tuberculosis may be considered in endemic countries in totally asymptomatic patients or complaining from unexplained and isolated abdominal pain, in absence of any morphologic or biochemical hepatic abnormalities.


Tuberculosis, Hepatic tuberculosis, Caseation necrosis, laparoscopic surgery



  1. H. M et al., “Tuberculosis cost in tunisia,” Tunis. Med., vol. 94, no. 8–9, Oct. 2016, Accessed: Sep. 12, 2023. [Online]. Available:https://pubmed.ncbi.nlm.nih.gov/28685796/
  2. N. Garmpis, C. Damaskos, A. Garmpi, A. Liakea, and D. Mantas, “The Unexpected Diagnosis of Hepatic Tuberculosis in an Immunocompetent Patient,” Case Rep. Surg., vol. 2020, pp. 1–4, Oct. 2020, doi: 10.1155/2020/7915084.
  3. S.-M. Zheng et al., “Isolated hepatic tuberculosis associated with portal vein thrombosis and hepatitis B virus coinfection: A case report and review of the literature,” World J. Clin. Cases, vol. 9, no. 30, pp. 9310–9319, Oct. 2021, doi: 10.12998/wjcc.v9.i30.9310.
  4. V. C. Hoe, A. Khairuddin, J. S. Tan, M. S. Sharif, N. Azizan, and F. Hayati, “Incidental hepatic tuberculosis during planned resection of locally advanced ampullary carcinoma: a case report,” BMC Surg., vol. 20, no. 1, p. 145, Jun. 2020, doi: 10.1186/s12893-020-00806-8.
  5. A. J. Hickey, L. Gounder, M.-Y. S. Moosa, and P. K. Drain, “A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection,” BMC Infect. Dis., vol. 15, p. 209, May 2015, doi: 10.1186/s12879-015-0944-6.
  6. P. Chaudhary, “Hepatobiliary tuberculosis,” Ann. Gastroenterol. Q. Publ. Hell. Soc. Gastroenterol., vol. 27, no. 3, pp. 207–211, 2014.
  7. W.-K. Lee et al., “CT appearances of abdominal tuberculosis,” Clin. Radiol., vol. 67, no. 6, pp. 596–604, Jun. 2012, doi: 10.1016/j.crad.2011.11.003.
  8. N. Quadir et al., “Development and Validation of Signature Sequence-Based PCR for Improved Molecular Diagnosis of Tuberculosis,” J. Mol. Diagn. JMD, vol. 23, no. 9, pp. 1138–1144, Sep. 2021, doi: 10.1016/j.jmoldx.2021.05.014.
  9. B. Ahmad, T. Ahmad, A. Ahmad, and M. Ahmad, “Liver segmentectomy surgery for delayed diagnosed hepatic TB, a case report from Syria,” Ann. Med. Surg., vol. 65, p. 102302, Apr. 2021, doi: 10.1016/j.amsu.2021.102302.