Download Intestinal Tuberculosis and more Study Guides, Projects, Research Medical Sciences in PDF only on Docsity! Intestinal Tuberclosis
Ulcerative T.B Hyperplastic ileocaecal T.B |
Incidence = Rare condition nowadays = Rare condition nowadays ,
usually in old age with poor usually in childhood with good
resistance . general health .
Aetiology =2"4 to pulmonary T.B . = try T.B.
& = Due to swallowing of infected = Due to ingestion of infected milk
Pathology sputum
= Usually human bacilli Usually bovine bacilli
= Multiple transverse T.B ulcers = The wall of the ileocaecal
(along course of lymphatics in region is markedly thickened
the submucosa ). with narrowing of the lumen .
= There is T.B lymphangitis .
= Tabes mesenterica ( T.B
lymphadenitis of mesenteric
LNs).
Complications |= Bleeding . = Stricture and 1.0 are common .
= Rarely perforation , fistula or |= Peri-intestinal abscess & fistula
stricture are rare
Clinical = T.B toxaemia .
picture = Diarrhoea , pain in right iliac fossa and sometimes intestinal
obstruction .
= Indurated mass in right iliac
fossa
= Manifestations of tabes
mesenterica & TB ascites .
Investigations |= Routine investigations for any T.B .( see T.B lymphadenitis )
* Occult blood in stool
= Abdominal U/S show ascites .
Intestinal T.B
= CT show enlarged mesenteric LNs , ascites , intestinal adhesions
= Rapid evacuation of barium =Barium meal follow through
from terminal ileum . show narrowing of terminal
ileum with proximal dilatation ,
elevated caecum .
Treatment
I) Mainly antituberculous drugs .
TI) Surgical treatment : for cases of intestinal obstruction .
TB enter
Ileocaecal TB : Elevated
Ileocaecal junction , narrow
terminal ileum with proximal
= Exision of affected segment . =Right hemicolectomy .
itis
Intestinal T.B
Tuberculous Peritonitis
* Incidence : Rare condition nowadays affects children or young age
* Aetiology : It is always secondary T.B due to spread of
infection to the peritoneum by one of the followings :
1) Direct spread from T.B salpingitis ( commonest cause ) ,
enteritis or lymphadenitis .
2) Lymphatic spread : from intestine or pleura .
3) Blood spread : usually from pulmonary T.B.
* Pathology :
e The peritoneum is studded with tubercles .
e Tuberculous peritonitis may be one of the following types :
1) Ascitic type:
= There is copious amount of straw coloured ascites .
= The greater omentum is thickened , fibrosed , rolled up
forming sausage shaped mass above the umbilicus .
2) Caseous type : (purulent type)
= Multiple collections of caseous material are present
between omentum and adherent intestine .
= Cold abscess and fistula can be formed .
Intestinal T.B
3) Localized encysted type :
= Fluid is encysted by adhesions and loops of intestine >
formation of intra-abdominal cyst which should be
differentiated from ovarian and mesenteric cysts .
4) Adhesive type :
= It is characterized by extensive peritoneal adhesions
which may lead to intestinal obstruction .
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* Clinical picture :
1) T.B toxaemia .
2) Abdominal distension and ascites .
3) Abdominal pain and tenderness .
4) Abdominal swellings which may be lymph nodes or thickened
omentum ( sausage shaped mass around umbilicus ).
Intestinal T.B
* Investigations :
1) Routine investigations for T.B .
2) Abdominal U/S show any encysted or free ascites or abdominal
swellings .
3) Tapping of ascitic fluid show clear fluid , straw coloured with
specific gravity above 1020 and rich in lymphocytes . Detection
of bacilli by PCR or culture.
4) Laparoscopic exploration show tubercles and permits biopsy .
* Treatment :
1) Antituberculous drugs .
2) Surgery : only for complications as 1.0 .
