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Only 6 patients (14%) showed a normal jejunum. The jejunum had by far the most severe changes observed in this series. Eighty-six percent of the patients had either mucosal fold thickening and distortion or abnormal caliber of the loops. In 26% dilated loops were observed, whereas in 21% the loops appeared contracted, and in 10% they were markedly narrowed and spastic. The deficiency pattern characteristic of malabsorption was seen in 50% of these patients with hookworm disease, with scattering of the barium column and segmentation and fragmentation of varying degrees (Figs. 12.9, 12.10, 12.11).


Fig.12.9 Hookworm disease in a missionary just returned from 5 years in West Africa. He suffered from anemia with a hemoglobin of 4 gm and chronic diarrhea. Hookworm eggs were found in his stools. (A) Throughout the small bowel series, there was slight dilatation of the mid-jejunal loops with coarsening of the folds. Also note flocculation and segmentation of barium in several ileal loops in the right abdomen, suggesting a mild "deficiency" or "malabsorption" pattern occasionally seen in patients with severe hookworm disease. (B) Spot film showing slight dilatation of the mid-jejunal loops and edema and thickening of the valvulae conniventes.



Fig. 12.10 Four patients with hookworm disease from Brazil. The patients in (B) and (C) also had hypoproteinemia and schistosomiasis mansoni. In (A-D) there is marked irritability and contraction of the small bowel loops from the duodenum to the mid-ileum, with the more marked changes seen in the duodenum and jejunum. There is considerable edema, thickening and spiking of the mucosal folds, again most severe in the proximal and mid-small bowel. In B and C there is marked scattering of barium with flocculation and segmentation of the column as in other malabsorption syndromes, probably in large part due to the associated hypoproteinemia in these patients. The combination of findings suggests both an inflammatory and malabsorptive process throughout the small bowel, most marked in the jejunum. (Courtesy of Dr. Antonio Filho, Sao Paulo).

Fig. 12.11 Hookworm disease in a patient from India. There are many spastic narrow loops of bowel in the duodenum and proximal jejunum, whereas the loops in the mid- and distal jejunum and ileum are moderately dilated. There is obvious edema and thickening of the mucosal folds in the proximal small bowel and there is moderate segmentation of the barium column. Once again, these findings suggest both an inflammatory and a malabsorption process. (Courtesy of Dr. Chandrahasan A. Johnson, Tulsa, Oklahoma).

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