Dr.Dinesh.M.G Professor of Surgery J.J.M.M.C Davangere

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Infections and infestations of
small intestine
 Intestinal tuberculosis
 Crohn’s disease
 Typhoid and paratyphoid
 Actinomycosis of right iliac fossa
 Round worm(Ascaris lumbricoides)

3. Intestinal tuberculosis
 Still common in India
 Aetiology
 Ingestion of food contaminated with Mycobacteria
 Swallowing of infected sputum of lung tuberculosis
 Spread from infected adjacent organs
 e.g. Fallopian tubes

4. Intestinal tuberculosis
 Intestinal tuberculosis
 Affects ileoceacal region & terminal ileum due to
 Abundance of lymphoid tissue
 Prolonged stasis
 Two types
 Ulcerative
 Hyperplastic

5. Ulcerative tuberculosis
Pathology
 Secondary to pulmonary tuberculosis due to swallowing
of bacilli
 Multiple transversely placed ulcers in the ileum
 Overlying thickened serosa shows tubercles
 Strictures may develop
 Perforation : Rare

6. Tuberculosis

7. Ulcerative tuberculosis
Clinical features
 Young adults between 20-40 yrs
 Known case of pulmonary TB
 Evening rise of fever, night sweats, malaise, anorexia &
dyspepsia
 Diarrhoea , weight loss & pain abdomen
 ‘Doughy feel’ of the abdomen
 Ascites
 Features of intestinal obstruction
 Features of peritonitis

8. Investigations
 Low Hb, lymphocytosis & raised ESR
 X-ray chest: pulmonary tuberculosis
 Usg abdomen
 Ascites
 Barium meal follow through
 Absence of filling of lower ileum, caecum & ascending
colon

9. Treatment
 Antitubercular medication
 Strictureplasty
 Resection & anastomosis of segment of intestine
 For intestinal perforation
 Multiple strictures of small segment

10. Hyperplastic tuberculosis
 Commonly affects ileocaecal region
 Thickened ileocaecal segment with narrowing of lumen
 Sub acute or acute intestinal obstruction develops
Clinical features
 Intermittent abdominal pain with diarrhoea
 Features of blind loop syndrome
 Steatorrhoea
 Anaemia
 Loss of weight
 Mass in the right iliac fossa

11. Hyperplastic tuberculosis
Investigations
 Plain x ray abdomen: calcified mesenteric lymph nodes
 Usg abdomen: ascites
 Barium meal follow through
 Pulled up caecum( sub hepatic)
 Obtuse ileocaecal angle
 Narrow terminal ileum

12. Hyperplastic tuberculosis
Plain x ray abdomen

13. Hyperplastic tuberculosis
Barium meal follow through

14. Hyperplastic tuberculosis
Treatment
 Antitubercular drugs
 Right hemicolectomy

15. Crohn’s disease(regional enteritis)
 Chronic non specific granulomatous condition
 Commonly affects terminal ileum and colon
 Aetiology : multifactorial
 Pathology
 Cicatrising inflammation with ulceration of the mucosa
 Cobble stone appearance of mucosa
 Intestinal wall is thickened (hose pipe)
 Thickened mesentery with enlarged lymph nodes
 ‘Skip’ lesions in the intestine

16. Crohn’s disease

17. Crohn’s disease(regional enteritis)
 Pain abdomen
 Diarrhoea
 Weight loss, low fever
 Mass in right iliac fossa
 Perianal abscess
 Enterocolic, vesicointestinal & enterocutaneous fistulae

18. Crohn’s disease(regional enteritis)
Investigations
Barium meal follow through
 ‘Cobble stone’ appearance
 ‘String sign’ of Kantor

19. Crohn’s disease(regional enteritis)
Treatment
 Medical
 Nutritional support
 Drugs
 Steroids
 Azathioprine
 Metronidazole
 Sulphasalazine
 Surgical
 Failure of medical treatment
 Intestinal obstruction
 Presence of fistulae

20. Crohn’s disease(regional enteritis)
 Surgical treatment
 Right hemicolectomy
 Segmental resection
 Strictureplasty
 Temporary ileostomy
 Colectomy

21. Surgical complications of Typhoid
& paratyphoid
 Paralytic ileus
 Intestinal haemorrhage
 Perforations
 Cholecystitis
 Phlebitis
 Genito urinary system: cystitis, pyelitis, epididymo
orchitis

22. Actinomycosis of right iliac fossa
Clinical features
 Follows appendicectomy
 Mass in the right iliac fossa
 Multiple indurated discharging sinuses in the abdominal
wall
 ‘Sulphur granules’ in the discharge
Treatment
 Penicillin
 Erythromycin
 Rifampicin

23. Round worm infestation
 A ‘ball’ of round worm may produce small bowel
obstruction
 Usually they are pushed to caecum
 In difficult cases enterotomy and extraction of worms

24. Tumours of small intestine
 Adenocarcinomas
 Lymphomas
 Carcinoid tumours
 Metastatic tumours
 Peutz – Jeghars hamartomas
 Circumoral mucocutaneous pigmentation
 Haemartomatous polyposis
 May produce haemorrhage or intussusception

25. Carcinoid tumour

26. Peutz-Jeghars syndrome

27. Points to remember
 Intestinal tuberculosis commonly affects ---------
 Terminal ileum or ileo caecal junction
 Hyperplastic tuberculosis should be considered for a mass
in the ------
 Right iliac fossa
 Features of hyperplastic ileocaecal tuberculosis on barium
meal follow through are ---
 Pulled up caecum, obtuse ileocaecal angle & narrow ileum
 Classical operation for obstructing hyperplastic ileocaecal
tuberculosis is -----
 Right hemicolectomy

28. Thank you