Management of Typhoid Ileal Perforation: A Surgical Experience of 44 Cases

Abdul Ghaffar Ansari, Syed Qaiser Hussain Naqvi, Ali Akbar Ghumro, Abdul Hakeem Jamali, Altaf Ahmad Talpur


Background: Typhoid perforation of ileum is a serious complication of typhoid fever. There are different surgical methods of repairing the perforation. The aim of this study was to report the surgical experience regarding treatment of typhoid ileal perforation in our setup.

Material & Methods: It wa a retrospective, observational study carried out at Departments of Surgery Unit I and Pathology, Peoples Medical College and Hospital Nawabshah from July 2003 to June 2008. Forty-four patients were admitted through causality as cases of acute abdomen, 28 (63.63%) were males and 16 (36.36%) females, with age range of 10-45 years. The diagnosis of typhoid perforation was made on clinical grounds, laboratory investigations, x-ray, ultrasound examination, and operative findings. Exploratory laparotomy was carried out and perforations were managed. The variables studied in the post operative period were wound infection, wound dehiscence, entero-cutaneous fistula, residual abscess, mortality, hospital stay and incisional hernia.

Results: Fever with abdominal pain and distension were the symptoms in all subjects followed by diarrhoea, vomiting and constipation Widal test more than 1:320 was positive in 35(79.45%) cases and typhi dot (IgM in all cases and IgG in 15) was positive in all cases. Blood culture was positive in 32 (72.7%) cases. X-ray abdomen revealed pneumoperitoneum in 22 (50%) cases. Ultrasound shows free peritoneal collection in 40 (90.90%) cases. On operation the abdominal cavity was heavily contaminated in 12 (27.27%) patients while in 32 (72.72%) patients the peritoneal cavity was having moderate contamination. 36 (81.81%) patients had single perforation & 8 (18.18%) patients had more than one perforation. In 32 (72.72%) patients perforations after freshening the ulcer were closed by single layered interrupted extra mucosal technique with vicryle 2/0, 4 (9.09%) needed resection & anastomosis & in remaining 8 (18.18%) loop ileostomy was made.

Conclusion: The typhoid ileal perforation still carries high morbidity and mortality. The typhoid ileal perforation should always be treated surgically. There are many operative techniques to deal typhoid ileal perforation but no one is fool proof. Regardless of the operative technique timely surgery within 24 hours with adequate and aggressive resuscitation is a way to decrease the morbidity and mortality.

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