A 24 year old female is with suspected appendicitis is taken up for surgery. However during surgery the appendix appears to be normal. Instead the Ileum is inflamed, enlarged with multiple adhesion. Surrouding fat is also involved. Possible diagnosis is –
Correct Answer: Ileocaecal tuberculosis
Description: Ans. is 'a' i.e., Ileocaecal tuberculosis o Tuberculosis of the small intestine occurs in two forms :# Primary infection is usually due to bovine strain of mycobacterium tuberculosis and results from ingesting infected milk. In India the human strain may also cause such primary tuberculosis. This produces hyperplastic tuberculosis# Secondary infection occurs due to swallowing of tubercle bacilli in a patient with pulmonary tuberculosis. This leads to ulcerative tuberculosis, the more common form of intestinal tuberculosis.A) Hyperplastic tuberculosiso Caused by ingestion of Mycobacterium tuberculosis by pts with a high resistance to the organism. The infection established itself in lymphoid follicles and the resulting chronic inflammation causes thickening of the intestinal wall and narrowing of the lumen. There is early involvement of the regional lymph nodes which may caseate.o Untreated sooner or later subacute intestinal obstruction will supervene often together with the impaction of an enterolith in the narrowed lumeno It usually occurs in the ileocecal region.Clinical features# Attacks of acute abdominal pain with intermittent diarrhoea.# Sometimes the presenting picture is of a mass in the rt iliac fossa in a pt with vague ill health.# Features of blind loop syndrome may develop due to stasis, distention and chronic infection in the segment of ileum proximal to obstruction.Barium meal radiography will reveal# Persistent narrowing of the affected segment i.e. the terminal ileum and the caecum.# The caecum is pulled up * and may become subhepatic.# As the caecum is pulled up the ileo-caecal angle is widened. Normal ileo-caecal angle is 900. In ileocaecal tuberculosis this angle may increase upto 1500.*Treatment: This depends on the presence or absence of obstructive symptoms.# ATT is given in both cases.# If obstruction is present ileocaecal resection is best method of t/t (along with ATT)B) Ulcerative tuberculosiso It is usually secondary to pulmonary tuberculosis and results from swallowing tubercle bacilli in the sputum (cf. Hyperplastic tuberculosis is usually primary there is no pulmonary tuberculosis)o Usually longer parts of the terminal ileum is involved.o There are multiple ulcers in the terminal ileum lying transversely o Pt presents with diarrhoea and wt losso Barium meal shows absence of filling of the lower ileum, caecum and most of the ascending colon as a result of narrowing and hypermotility of the ulcerated segment.Treatment# A course of A TT is adequate# Operation is rarely required, in rare events of perforation or intestinal obstruction.
Category:
Surgery
Get More
Subject Mock Tests
Practice with over 200,000 questions from various medical subjects and improve your knowledge.
Attempt a mock test nowMock Exam
Take an exam with 100 random questions selected from all subjects to test your knowledge.
Coming SoonGet More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now