Posted in Volume 15 - Number 4 Suppl
GHULAM SHABIR SHAIKH, QURATULAIN SOOMRO, AFSAR ALI BHUTTO, YASMEEN BHATTI, RAJIB ALI DEENARI, IMAMUDDIN BALOCH
ABSTRACT | Full Text PDF
OBJECTIVE: The purpose of our study was to review our experience of clinical profile and management of typhoid ileal perforation over past 3 years.
BACK GROUND: Typhoid perforation is a serious complication and remains a significant surgical problem in developing countries, where it is associated with high mortality and morbidity, due to lack of clean drinking water, poor sanitation and lack of medical facilities in remote areas and delay in hospitalization.
PATIENTS AND METHOD: The study is prospective descriptive study carried out during period of 3 years from 15th June 2006 to 14th June 2009 at department of surgery unit II, Chandka Medical College Teaching Hospital Larkana. A total of 62 patients diagnosed with typhoid illeal perforation admitted through OPD and Emergency department were included in the study. A written informed consent was obtained from each patients before enrolling them to study, the data was collected on printed proforma and included demographic area, clinical features, laboratory investigations, x-rays and ultrasonography findings , and operative findings, duration of hospital stay, postoperative complications, and mortality.
RESULTS: A total of sixty Two (62) patients were diagnosed with typhoid illeal perforation during the period under review.There were 47 (75.8 %) males and 15 (24.2%) females with age ranging from 13 to above 50years.The majority of patients presented with abdominal pain 58 (93%), fever 53 (85%), and 47(75%) abdominal distention. Widal test was positive in 41(66%) patients and pneumoperitoneum was identified in chest radiographs of 45(72.5%) patients and multiple air fluid levels in abdominal radiographs of 48(77%). Ultrasonography of abdomen and pelvis showed intraperitoneal collection in 91.93% (n=57). Peroperatively single perforation was found in 50 (80.64%) and two perforations in 09 (14.5%) patients and 03 (4.83%) patients were found to have multiple perforations. 22 (35.48%) patients developed postoperative wound infections, 06 (09.67%) patients developed respiratory tract infections, 06 (9.6%) patients developed fecal fistula, and 10 (16.12%) patients developed septicemia and 06 (9.6%) developed shock. Mortality was 24.1% (15 ).
CONCLUSION: The typhoid ileal perforation is 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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