DEMOGRAPHIC AND SURGICAL EVALUATION OF TYPHOID ILEAL PERFORATION
AbstractBackground: Typhoid perforation of small intestine is one of the most common causes of bowelperforation in the developing countries. The purpose of this study was to determine the prevalence,factors affecting prognosis, and optimal surgical management for typhoid perforation in Sindh.Method: One hundred and thirty patients with typhoid perforation were included in the study from July2005 to June 2007 in the Department of Surgery, Liaquat University Hospital, Hyderabad. Patientswere admitted as cases of acute abdomen. Detailed history, clinical examination and relevantinvestigations were carried out. Double layer primary closure, primary loop ileostomy and segmentalresection with end-to-end anastomosis were performed according to the operative findings andcondition of the patients. Attention was paid to postoperative complications and course of the morbidcondition. Results: Majority of patients belonged to deserted areas of district Umerkot (n=35, 26.93%),and Mithi (n=20, 15.38%) followed by Dadu (n=17, 13.08%), Badin (n=15, 11.54%), Jamshoro (n=11,8.46%), Hyderabad (n=10, 7.69%), Thatta (n=9, 6.92%), Mirpurkhas (n=7, 5.38%) and Sanghar (n=6,4.62%). Double layer primary closure of single perforation was done in 50 (38.46%) patients, primaryloop ileostomy was performed in 68 (52.30%) patients and primary resection and end-to-endanastomosis was performed in 12 (9.23%) patients. Postoperative complications were observed in 79(60.76%) patients. Wound infection was the commonest complication seen in 70 (53.84%) patientsfollowed by wound dehiscence in 10 (7.69%), faecal fistula in 9 (6.92%), septicaemia in 8 (6.15%),postoperative chest infection in 25 (19.23%), and intra abdominal abscess in 15 (11.53%) patients. Ten(7.69%) patients died due to septicaemia and other reasons. Conclusion: Typhoid perforation remains afrequently fatal illness with high prevalence in remote areas of Sindh. Primary loop illeostomy is thesingle most successful and life saving surgical procedure in terms of overall morbidity and mortality.Keywords: Typhoid perforation, demography, surgical procedure, end-to-end anastomosis, Sindh
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