TYPHOID ENTERIC PERFORATION: PROGNOSTIC FACTORS AN EXPERIENCE WITH 76 PATIENTS

Afzal Khan

Abstract


Background: In spite of the world wide improvement in public awareness of hygiene and good sanitation there are
still some parts of the world where the number of typhoid enteric perforation is rising day by day. Typhoid enteric
perforation if on one hand is a cause of increased morbidity and mortality for the patients, on the other hand it is
becoming a common surgical problem for the surgeon. Methods: A retrospective study of 76 patients of typhoid
enteric perforation was carried out with the aim to evaluate the factors contributing to the increasing incidence &
delayed diagnosis of the disease. More specifically the various surgical procedures used for the treatment of typhoid
enteric perforation & its results were evaluated. All the 76 patients w-ere admitted in the Surgical "C" Unit of Khyber
Teaching Hospital from January 1991 to Dec 1994. Results: The highest incidence was found in the second decade
of life (36.84%). Male to female ratio was 2.1. The common presenting symptoms were fever (100%) followed by
pain abdomen (76.31%). The Widal test was positive only in 71 patients while gas under the diaphragm was found in
45 cases. At Laparotomy 74 patients (97.36%) were found to have ileal perforation as compared to jejunal perforation
in 2 cases. Faecal peritonitis was observed in 54 (59.21%). In 59 patients primary closure of the perforation was
performed. While in 11 patient’s exteriorization of perforation as temporary ileostomy was performed. 12 patients out
of 59 with primary closure of the perforation re-perforated and added to considerable postoperative morbidity and
mortality. On the other hand, 11 patients with the primary exteriorization of perforation as temporary ileostomy did
very well The overall mortality rate was (22.35%). Conclusion: Early diagnosis and primary exteriorization of the
perforation as temporary ileostomy can decrease morbidity and mortality considerably.

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