For undergraduates

1. Inflammatory bowel
disease
By Dr Mohamed Ezzat
Demonstrator of surgical oncology
Oncology Center Mansoura University

2. Usually used to denote Ulcerative colitis and Chron’s
disease.
However IBD can be caused by other diseases ….
Bilharziasis , TB , Amebiasis and typhoid

3. Ulcerative colitis
Etiology
Unknown ( autoimmunity , genetic & environmental
risk factors)
Pathology
Start in rectum (Proctitis) 95%
Extend proximally (Pancolitis) ** back wash ileitis
No skip lesion
Mucosa & submucosa
Pseudo Polyps
Shortening of the bowel

4. Clinical picture
1. Acute fulminant type 5%
2. Chronic type 95%
Bloody diarrhea, abdominal tenderness& distension
DRE: gritty rectal mucosa with blood and mucous on
examining finger

5. Complications
A) Intestinal
Toxic megacolon
Massive haemorrhage
Malignancy
Malabsorption
Perforation
Stricture
Anorectal complications

6. B) Extraintestinal
Skin & MM >> Erythema
nodosum & Stomatitis
Eye >> Uveitis
Joints >> Arthritis
Hepato-biliary >> 2ry
sclerosing cholangitis ,
cirrhosis & bile duct
carcinoma
Anaemia & malnutrition

7. Investigation
Stool analysis >> Exclude amebic & bacillary
dysentery
CBC >> Anemia
Barium Enema ??
Pipe stem colon
Pseudo Polyps
Endoscopy & Biopsy

8. Treatment
Medical:
Salazopyrine
Steroids
Antibiotics
Azathioprine(Immuran)®
TNF α blocker (Infliximab)®

9. Surgical
Indications
Failure of medical treatment
Complications
Procedures
Total proctocolectomy and ileoanal pouch
Total proctocolectomy and terminal ileostomy
Total colectomy, rectal mucosectomy and ileorectal
anastmosis

10. Chron’s disease
Etiology >> Unknown ( autoimmunity , genetic &
environmental risk factors)
Pathology
Affect any part of GIT … Distal ileum
Transmural
Skip lesions
Cobble stone appearance
Fibrous tissue formation & Stricture

12. Clinical picture
1. Acute fulminant type 5% >> similar to acute
appendicitis
2. Chronic type 95%
Recurrent abdominal pain
Diarrhea
Mass in rt iliac fossa
Complications

13. Complications
A) Intestinal
Stricture
Perforation: abscess and fistula formation
Anorectal complications
Malabsorption
Toxic megacolon
Massive haemorrhage
Malignancy

14. B) Extraintestinal
Skin & MM >> Erythema
nodosum & Stomatitis
Eye >> Uveitis
Joints >> Arthritis
Hepato-biliary >> 2ry
sclerosing cholangitis ,
cirrhosis & bile duct
carcinoma
Anaemia & malnutrition

15. Investigation
Stool analysis >> Steatorrhea
CBC >> Anemia
Barium follow through& Enema ??
String sign of cantour
Segmental stricture
Cobble stone appearance
Fistula
CT & MRI
Endoscopy & Biopsy

16. Treatment
Medical
Salazopyrine
Steroids
Antibiotics
Azathioprine(Immuran)®
TNF α blocker (Infliximab)®

17. Surgical treatment
Indications
Failure of medical treatment
Complications
Procedures
Conservative resection
Stricturoplasty
Temporary loop ileostomy

18. Don’t forget
Ulcerative colitis Chron’s
Lt side … Rectum Rt side … terminal ileum
Mucosa & submucosa Transmural
Pseudo Polyp Fistulae
Malignant transformation Stricture
Toxic megacolon Obstruction

19. Bilharzial Colitis
Common in young males living in rural areas
Etiology: mainly Schistosoma Mansoni
Not precancerous
C/P: Portal HTN, Dysentery
Investigations : stool analysis, sigmoidoscopy
Treatment : Antibilharzial drugs + surgical intervention
according to the finding

20. TB of the intestine
Ulcerative type Hypertrophic type(<10%)
2ry to pulmonary TB. (Adult) ingestion of the TB bacilli. (Child)
Mycobacterium tuberculosis. Mycobacterium bovis.
terminal ileum Ileocaecal region.
transverse ulcers thickening
Stricture (IO) Stricture (IO)
Perforation Fistula formation
Treatment : Anti TB drugs and surgery for complications

22. Surgical complications of Typhoid
and Paratyphoid
Paralytic ileus (the commonest
complication).
lntestinal bleeding
Perforation of the typhoid ulcer
Biliary complications (Acute non-calcular
cholecystitis & Chronic cholecystitis)
DVT of the lower limbs
Arthritis and osteomyelitis