OPERATIVE FINDINGS
The
early changes observed are marked
hyperemia, dullness and
fine
granularity of the
serosal surface, oedema
and soft
thickening of the
bowel wall with oedema of the corresponding
mesentery.
Intestinal segements
involved in chronic
regional enteritis
present a very characteristic
appearance.
*
The colour is dull, purple red
and the wall is thickened to
two or three times normal diameter.
*
Mesenteric fat is present over the serosa
*
Bowel wall is very firm, rubbery and incompressible.
*
segments are often adherent to adjacent loops
*
Loops may be matted together into a mass
*
Internal fistulas are frequently present in this mass,
the
mesentery is thickened, dull, rubberywith lymphnode masses of
upto 3 or 4 cm. in size.
The
proximal bowel is often dilated because of the
obstruction
present in the diseased segment.
TREATMENT
There
is no curative therapy, systemic antibiotics are of value
in the management of complications.
Nonabsorbable antibiotics,
particularly salicylazo-sulfapyridine
(Salazopyrin) exert a beneficial
effect on the symptoms.
Treatment with corticosteroids have
been disappointing.
SURGICAL INDICATIONS
In general, failure of medical therapy
is the indication for the
operative intervention.
Surgical treatment
is used to correct
complications that are
themselves producing serious symptoms.
Simple
bypass of the diseased segment and
resection of the
diseased segment are practiced.
BLIND LOOP
Stasis of intetinal contents in a
blind loop e.g. diverticulitis
or
a long loop in after gastric
surgery can produce
symptoms
usually.
*
Malabsorbtion
*
Diarrhoea and
*
Anaemia
Symptoms can be improved by antibiotics but
surgical correction
excising the blind loops can cure.
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