Nasobiliary Drainage for Intrahepatic Cholestasis and Pruritus Refractory to Medical Therapy: A Series of Three Cases

Abstract

In addition to GB wall thickening on imaging, which was suspicious of malignancy, the patient had palpable supraclavicular nodes that were metabolically active on a whole-body PET scan without any metabolic activity in regional abdominal lymph nodes. In this case, metastatic involvement of supraclavicular nodes will make the tumour unresectable. Given suspicion for metastasis, USG guided supraclavicular lymph node FNAC was done. However, when FNAC was done, metabolic activity seen on PET scan in the supraclavicular was indeed due to tubercular lymphadenitis with the presence of granulomas. We previously described the association of tuberculosis in cases of GB cancer, which can influence staging and further management. Seven patients had tuberculosis in association with carcinoma gall bladder. Two patients had supraclavicular lymph nodes, two patients were detected to have TB in inter aortocaval nodes, and one had peritoneal tubercular nodules. Two patients had tuberculosis in dissected hepatoduodenal ligament lymph nodes. At least five of the seven patients would have been deemed unresectable if sampling of nodes was not done. Hence, FNAC and lymph nodes sampling need to be done when IAC or left supraclavicular nodes are involved in a case of carcinoma gallbladder in an otherwise resectable disease.5