This document discusses various infections and infestations of the small intestine, including intestinal tuberculosis, Crohn's disease, typhoid, actinomycosis, and roundworm infestation. It provides details on the pathology, clinical features, investigations, and treatment of intestinal tuberculosis, focusing on the ulcerative and hyperplastic types. It also discusses Crohn's disease, noting the ailments it commonly affects and its characteristic cobblestone appearance. Surgical complications of typhoid and approaches for managing roundworm infestation are briefly covered as well.

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