Primary duodenal tuberculosis in an 8-year-old child with gastric outlet obstruction

Primary duodenal tuberculosis (TB) is a rare condition, particularly among children that is easily misdiagnosed even in endemic areas. We present a rare case report of primary duodenal TB in an 8-year-old child who presented with gastric outlet obstruction. Endoscopy-guided biopsies were non-conclusive. The patient underwent exploratory laparotomy and during surgery, a 5 cm×5 cm mass was observed in the first part of the duodenum with thickening of the duodenal wall and mesenteric lymphadenopathy. Multiple biopsies were taken from the mass and lymph nodes, and a gastrojejunostomy was performed to relieve the obstruction. Histopathological examination of the duodenal mass and the lymph node samples showed caseating granuloma and giant cells, which are consistent with duodenal TB. The patient received a 6-month regimen of anti-tubercular treatment including 2 months of isoniazid, rifampicin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampicin; he has remained asymptomatic on 3 monthly follow-ups for the past 18 months.