The Outcome of Surgery for Typhoid Intestinal Perforation
Abstract
ABSTRACT
Background: Intestinal perforation is the most serious complication of typhoid disease and surgery is the gold standard treatment which may be complicated by serious problems post operatively
Objective: To assess the outcome of different surgical procedures in the management of perforated typhoid ulcer.
Methods: A retrospective analytic study of 62 patients, who had been admitted to AlKindy teaching hospital, in Baghdad, Iraq, in the period from April 2009 - April 2011. All patients were subjected to laparotomy because of perforated typhoid ulcers
Results: The most common presenting symptoms were severe abdominal pain and fever, followed by abdominal distension, diarrhea, vomiting and constipation. At explorative laparotomy, single terminal ileal perforation was found in 47(75.8%) patients while 15 (24.2%) patients have multiple perforations. In all cases, perforation was in the last 10-50 cm of the terminal ileum. Simple trimming of the edges and refreshing was done in 46(74.1%) patients, resection and anastomosis was performed to multiple perforations in a nearby site in 9 (14.5%) patients and exteriorization of the affected segment in the form of ileostomy was done in seven (11.2%) patients. The most common postoperative complications were; wound infection in 18 (29%) patients followed by prolonged ileus (more than 72 hours) in16 (25.8%) patients.
Conclusion: Degree of soiling and peritonitis secondary to the time delay factor was directly related to the degree of mortality in spite of proper surgical procedure choice.
Copyright (c) 2012 Iraqi Medical Journal
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