• Arshad Hussain Abro
  • Faisal Ghani Siddiqui
  • Sarfraz Ahmad


Background: 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


McConkey SJ. Case series of acute abdominal surgery in rural

Sierra Leone. World J Surg 2002;26:509–13.

Kouame J, Kouadio L, Turquin HT. Typhoid ileal perforation:

surgical experience of 64 cases. Acta Chir Belg 2004;104:445–7.

van der Werf TS, Cameron ES. Typhoid perforation of the ileum:

a review of 59 cases seen at Agogo Hospital, Ghana between

and 1987. Trop Geogr Med 1990;42:330–6.

Bitar F, Tarpley Y. Intestinal perforation in typhoid fever:

historical and state-of-the-art review. Rev Infect Dis 1985;7:257–

World Health Organization. 6th International conference on

typhoid fever and other Salmonelloses. Geneva: WHO; 2006.

Hussain W, Aslam M, Haider A, Jaffery G, Malik A. Clinical

spectrum of typhoid fever in children in a descriptive study at

Sheikh Zaid Hospital Lahore. Pakistan Paediatr J 2002;26:71–5.

Adesunkanmi AR, Ajao OG. The prognostic factors in typhoid

fever ileal perforation. A prospective study of 50 patients. J R

Coll Surg Edinb 1997;42:395–9.

Bashir M, Nadeem T, Iqbal J, Rashid A. Ileostomy in Typhoid

perforation. Ann. King Edward Med Coll 2003;9(1):1–3.

Malik AM, Laghari AA, Mallah Q, Qureshi GA, Talpur AF,

Effendi S, et al. Different surgical options and ileostomy in

typhoid perforation. World J Med Sci 2006;1(2):112–6.

Khan JS, Hassan H, Bhopal FG, Mehmood N, Taj N, Khan JA,

et al. Typhoid perforation: a ten year experience in surgical unit. J

Rawal Med Coll 2002;6:70–3.

Agbakwuru EA, Adesunkanmi AR, Fadiora SO, Olayinka OS,

Aderonmu AO, Ogundoyin OO. A review of typhoid perforation

in a rural African Hospital. West Afr J Med 2003;22(1):22–5.

Crump JA, Luby SP, Mintz ED. The global burdun of typhoid

disease. Bull World Health Organ 2004;82:346–53.

Hyckstep RL. Recent advances in the surgery of typhoid fever.

Ann R Coll Surg Engl 1960;26:207–30.

Ramachandran CS, Agarwal S, Dip DG, Arora V. Laparoscopic

surgical management of perforative peritonitis in enteric fever. A

preliminary study. Surg Laparosc Endosc Percutan Tech


Bhansali, SK. Gastrointestinal perforation: a clinical study of 96

cases. J Postgrad Med 1967;13(1)1–12.

Shahzad K, Akhtar I, Ijaz A, Khan MM Outcome of Ileostomy in

cases of typhoid perforation presenting after 48 hours. J Rawal

Med Coll 2000;4:17–9.

Ameh EA, Dogo PM, Attah MM, Nmadu PT. Comparison of

three operations for typhoid perforation, Br J Surg 1997;64:558–

Wani RA, Parray FQ, Bhat NA, Wani MA, Bhat TH, Farzana F.

Nontraumatic terminal ileal perforation. World J Emerg Surg

;1:7. doi:10.1186/1749-7922-1-7.

Shah AA, Wani KA, Wazir BS. The ideal treatment of the

typhoid enteric perforation –resection anastomosis. Int Surg




Most read articles by the same author(s)