1. Treatment and Management

2. Stabilize the Patient Airway Breathing Circulation

3. Initial Relief Insert nasogastric tube – Decompress the stomach and keep it free from air and liquid – Relief of distension and vomiting

4. Surgical Lapatoromy – Surgical resection of the affected segments (possibly the ileocecal segment)

5. Medical The patient is diagnosed to have active TB – Consider the possibility that patient now has drug resistant strain Patient was already treated with TB before which was allegedly resolved through chest xray – However, chest xray sometimes show clear findings even with infection – Enroll the patient in DOTS program again

6. Medical If considering multi-drug resistant strain DurationDrugsDosage 56 daysIsoniazid175 mg OD Rifampicin350 mg OD Pyrazinamide875 mg OD Ethambutol700 mg OD Streptomycin525 mg OD 28 daysIsoniazid175 mg OD Rifampicin350 mg OD Pyrazinamide875 mg OD Ethambutol700 mg OD 140 daysIsoniazid175 mg OD Rifampicin350 mg OD Ethambutol700 mg OD

7. Medical If considering TB infection as relapse – Definition: previously treated with one full course of therapy under DOTS and has been declared cured but became smear positive again DurationDrugs 2 monthsIsoniazid, Rifampicin, Pyrazinamide, Ethambutol, and Steptomycin 1 monthHRZE 5 monthsHRE or (2HRES/1HRZE/5HRE) * Give Pyridoxine 875mg OD at night for patients with peripheral neuropathies

8. Monitoring and Follow-up

9. Monitoring and follow-up The patient’s nutritional status should be constantly monitored The patient should be monitored whether reintroduction of oral feeding could already be tolerated Function of the resected segment of the intestine should be assessed Patient’s intake of TB medications should be monitored

10. Prevention

11. As an extension of the DOTS strategy, contract tracing should be done – Detect other cases and prevent further spread of TB infection – Targeted contact tracing among family members and close contacts of the patient

12. Prognosis

13. If patient is not treated with surgery and TB medications – Prognosis is poor because patient has possible drug resistant TB of the lungs which spread to the gastrointestinal tract to cause obstructive symptoms If patient is treated with surgery and TB medications – Prognosis is good because one surgery is done to relieve the obstruction, the patient can tolerate food again and improvement in nutritional status can be maintained – Drug resistant TB could still be resolved with the DOTS program for drug resistant strains.