Inflammatory bowel disease

By Dr Mohamed EzzatDemonstrator of surgical

oncologyOncology Center Mansoura

University

Usually used to denote Ulcerative colitis and Chron’s disease.

However IBD can be caused by other diseases .… Bilharziasis , TB , Amebiasis and typhoid

Ulcerative colitisEtiology

Unknown ( autoimmunity , genetic & environmental risk factors)PathologyStart in rectum (Proctitis) 95%Extend proximally (Pancolitis) ** back wash ileitisNo skip lesionMucosa & submucosaPseudo PolypsShortening of the bowel

Clinical picture1 .Acute fulminant type 5%

2 .Chronic type 95%

Bloody diarrhea, abdominal tenderness& distension

DRE: gritty rectal mucosa with blood and mucous on examining finger

ComplicationsA) IntestinalToxic megacolonMassive haemorrhageMalignancyMalabsorption

PerforationStrictureAnorectal complications

B) ExtraintestinalSkin & MM >> Erythema nodosum & StomatitisEye >> UveitisJoints >> ArthritisHepato-biliary >> 2ry sclerosing cholangitis , cirrhosis & bile duct carcinomaAnaemia & malnutrition

InvestigationStool analysis >> Exclude amebic & bacillary dysenteryCBC >> Anemia

Barium Enema?? Pipe stem colonPseudo Polyps

Endoscopy & Biopsy

TreatmentMedical:

SalazopyrineSteroidsAntibiotics

Azathioprine(Immuran)®TNF α blocker (Infliximab)®

SurgicalIndicationsFailure of medical treatmentComplications

ProceduresTotal proctocolectomy and ileoanal pouchTotal proctocolectomy and terminal ileostomyTotal colectomy, rectal mucosectomy and ileorectal anastmosis

Chron’s diseaseEtiology >> Unknown ( autoimmunity , genetic & environmental risk factors)

PathologyAffect any part of GIT … Distal ileum

TransmuralSkip lesionsCobble stone appearanceFibrous tissue formation & Stricture

Clinical picture1 .Acute fulminant type 5% >> similar to acute

appendicitis

2 .Chronic type 95%Recurrent abdominal painDiarrheaMass in rt iliac fossaComplications

ComplicationsA) IntestinalStricturePerforation: abscess and fistula formationAnorectal complicationsMalabsorption

Toxic megacolonMassive haemorrhageMalignancy

B) ExtraintestinalSkin & MM >> Erythema nodosum & StomatitisEye >> UveitisJoints >> ArthritisHepato-biliary >> 2ry sclerosing cholangitis , cirrhosis & bile duct carcinomaAnaemia & malnutrition

InvestigationStool analysis >> Steatorrhea

CBC >> Anemia

Barium follow through& Enema?? String sign of cantourSegmental strictureCobble stone appearanceFistulaCT & MRI

Endoscopy & Biopsy

TreatmentMedicalSalazopyrineSteroidsAntibiotics

Azathioprine(Immuran)®TNF α blocker (Infliximab)®

Surgical treatment

IndicationsFailure of medical treatmentComplications

ProceduresConservative resectionStricturoplastyTemporary loop ileostomy

Don’t forgetUlcerative colitis Chron’s

Lt side … Rectum Rt side … terminal ileum

Mucosa & submucosa Transmural

Pseudo Polyp Fistulae

Malignant transformation Stricture

Toxic megacolon Obstruction

Bilharzial Colitis

Common in young males living in rural areasEtiology: mainly Schistosoma MansoniNot precancerousC/P: Portal HTN, DysenteryInvestigations : stool analysis, sigmoidoscopyTreatment : Antibilharzial drugs + surgical intervention according to the finding

TB of the intestine

Ulcerative type Hypertrophic type(<10%)

2ry to pulmonary TB. (Adult) ingestion of the TB bacilli. (Child)

Mycobacterium tuberculosis. Mycobacterium bovis.terminal ileum Ileocaecal region.

transverse ulcers thickening

Stricture (IO) Stricture (IO)

Perforation Fistula formation

Treatment : Anti TB drugs and surgery for complications

Surgical complications of Typhoid and Paratyphoid

Paralytic ileus (the commonest complication).lntestinal bleedingPerforation of the typhoid ulcerBiliary complications (Acute non-calcular cholecystitis & Chronic cholecystitis)DVT of the lower limbsArthritis and osteomyelitis