Port site tuberculosis after laparoscopic cholecystectomy in resource limiting setup: Case series and literature review

Abstract

INTRODUCTION AND IMPORTANCE: Laparoscopic cholecystectomy has become the gold standard for treating symptomatic gallstones in recent years due to its minimally invasive nature, which results in less pain, scarring, and a faster recovery time compared to traditional open surgery. Port site infection is a rare complication of laparoscopic surgery, sometimes occurring early after the procedure or developing later and the cause of these infections can vary. Port site tuberculosis (TB) is a particularly uncommon type of port site infection and represents a rare form of extra pulmonary TB. CASE PRESENTATION: Three patients (a 63-year-old diabetic male, a 62-year-old hypertensive female, and a 34-year-old female) presented with port site discharge and pain after undergoing laparoscopic cholecystectomy at the same center during the same campaign. All patients initially received antibiotics for suspected port site infections, but these failed to resolve the symptoms. Subsequent fine needle aspiration cytology revealed port site tuberculosis (TB) in all three cases. After initiating anti-tuberculosis treatment, all patients showed significant improvement. CLINICAL DISCUSSION: Port site tuberculosis, a rare and often overlooked extra pulmonary manifestation of tuberculosis, can present as a port site infection following laparoscopic procedures. It is characterized by prolonged wound healing and persistent discharge, can pose diagnostic challenges, often requiring careful evaluation and appropriate investigations to ensure timely and effective treatment. Port site tuberculosis can be transmitted to patients through two main routes: exogenous or endogenous ways. Once a diagnosis of port site tuberculosis is confirmed; the next step involves treatment with a standard anti-tuberculosis regimen. CONCLUSION: Port site tuberculosis (TB) after undergoing laparoscopic cholecystectomy at the same facility, suggesting inadequate instrument sterilization as a likely cause. This case underscores the importance of considering port site TB in post-laparoscopic patients, particularly in areas with high TB prevalence, after ruling out bacterial infections. Prompt and appropriate treatment is crucial for successful outcomes.