SMALL INTESTINES Disorders 4 enteritis

2.2 INFLAMMATORY DISEASES

2.2.1 TYPHOID ENTERITIS

An  acute,  systemic infection caused by  Salmonella  Typhii  and

manifests with:

*  Fever

*  Headache

*  Prostration

*  Maculopapular rash

*  Abdominal pain

*  Leucopenia

The   surgical  complications  of  this  infection  are  due   to

hyperplasia  and ulceration of Payer's patches of  the  intestine

and mesenteric lymphadenopathy Fig. 18.2

Confirmation of diagnosis is obtained by culturing S; typhii from

blood  or feces or by finding a high titre of agglutinin  against

the O and H antigens in the serum.

Chloramphenicol  is  given  orally in doses of  60mg/Kg  of  body

weight/day in four divided doses until the temperature is normal,

then reduced to 30mg/kg/day for a total of two weeks.

Ampicillin is also effective and should be given intravenously or

intramuscularly in does of 1 gm every 6 hours for two weeks.

MANAGEMENT

Gross haemorrhage occurs in 10 to 20% of patient even while  they

are on adequate therapy.

-  Perforation  of the ulcerated Payer's patches occurs in  about

   2%

-  Like  haemorrhage,  this complication should also  be  handled

   conservatively

   Chloramphenicol or ampicillin are given intravenously in large

   doses.

-  Nasogastric suction is started

-  Blood, serum albumin and fluids and electrolytes are given  as

   indicated.

-  An  operative approach should be considered only in  good-risk

   patients who are seen within 6 hours of the perforation.

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SMALL INTESTINES Disorders 3 Meckel"s Diverticulum

2.1.6 MECKEL'S DIVERTICULUM

Meckel's  diverticulum  is on the antimesenterric border  of  the

ileum about 1 ft. from the ileocecal valve.

*  A  persistant  fibrous band or sinus may connect it  with  the

   umbilicus.  Most common complication of Meckel's  diverticulum

   in the adult is intestinal obstruction.

*  Bleeding   is   also   a   common   manifestation.    Meckel's

   diverticulitis    clinically   is    indistinguishable    from

   appendicitis  is  the third complication in  the  adult.   The

   incidence of perforation and peritonitis is about 50%

*  Prophylactic  removal  of  incidentally  encountered  Meckel's

   diverticulum is indicated whenever it is possible with safety.

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SMALL INTESTINES Disorders 2 Vittello-intestinal tract Meconium ileus

2.1.3 MECONEUM ILEUS

This  occurs  in the new born and is due to  fibrocystic  disease

(muco-viscidosis).  The  terminal part of the ileum  is  full  of

vercid neconium.  The child is born with obstruction.

Treatment  laprotomy  is required.  This has  been  discussed  in

Paediatric surgery chapter.

2.1.4 VITELLO-INTESTINAL TRACT

Congenital  persistance  of  this tract after  the  7th  week  of

intrauterine life results in - umbilical polyp.

The  child has a cherry red polyp mass at the umbilicus there  is

blood stained mucoid discharge.

2.1.5 PERSISTANT VITELLE INTESTINAL DUCT

These patients present later in life (18 years) with an umbilicul

polyp  and blood stained mucoid discharge occassionally there  is

discharge  of fecal content.  This requires exploration  and  the

entire tract excised.

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Small Intestines 3 Disorders 1

2.1.1 LADDS BAND

A congenital defect due to non descent of the ceacum a peritoneal

band  streches  across  the second part of  the  duodeneum.   The

patient presents with duodenal obstruction.  Early operation   is

required to divide the band and relieve the obstruction

2.1.2 Intestinal  atresia  non canalisation of  the  intestines  during

development occurs in one in 2000 births. It is suspected this is as a

result  of interferance with the blood supply of the  atretic segment  of

in utero.  The sites are:

Duodenum                30 percent

Ileum                         25%

Multiple sites             17%

Jejunium                    15%

Colon                        10%

This  is  the  commonest cause of obstruction in  the  new  born. 

There is bilious vomiting.  The management of this condition  has

been discussed in the Paediatric surgery chapter

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