A Clinical Profile of Typhoid Perforation of Bowel in a Tertiary Care Centre

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Authors

  • Sudhir Bhamre
     ,IN
  • Sushma S. Chandak
     ,IN
Education and Research

Abstract

Background and Aims: Salmonella typhi causes an estimated 22 million cases of typhoid fever and 216000 deaths annually worldwide1 and in developing countries, typhoid bowel perforation is an important surgical problem. The surgeon is faced with number of challenges during the management of these patients. The aims of this study are 1. To study the clinical profile of typhoid perforation of bowel in a tertiary care centre. 2. To study post operative outcome in patients with typhoid ulcer perforation. Methods and Methodology: A total of 45 patients diagnosed as having typhoid bowel perforation were included for the study after fulfilling the inclusion/ exclusion criteria. Results: Majority of patients were in the 2nd and 3rd decades (57.7%) with age ranging from 18 to 68 years. There were 28 (63.63%) males and 17 (37.7%) females. Fever with abdominal pain were the symptoms in all subjects followed by vomiting, distension of abdomen and constipation respectively. Most of the patients presented during 2nd and 3rd week of illness. 5 patients presented early i.e. within 24 hours and 40 patients presented late i.e., after 24 hours. Widal test was positive in 35 (79.45%) cases. Majority of patients (66.6%) group showed leucocytosis, while 7% showed leucopenia and 17% had normal WBC counts. Single perforation was found in 27 patients (60%), 2 perforations in 14 patients (31.1%) and more than 2 perforations were found in 4 patients (8.8%). Gas under diaphragm was present in all the patients. The most commonly done procedure in 33 cases (73.33% ) was simple closure of the perforation and resection and end to end ileo ileal anastomosis was done in 10 patients whereas ileo transverse anastomosis with ileostomy was done in 2 patients with multiple perforations. The most common post-operative complication was surgical site infection followed by respiratory infections, wound dehiscence. Enterocutaneous fistula was present in one case Mortality rate of 6.6 % was seen.

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Published

2016-11-17

Issue

Volume 3, Issue 2, July-December 2016

Section

Original Research Article

 

References

Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004; 82:346–53.

Ukwenya AY, Ahmed A, Garba ES. Progress in management of typhoid perforation. Ann Afr Med. 2011; 7:259–65.

Kotan C, Kosem M, Tuncer I, Kisli E, Sonmez R, Cıkman O, Soylemez O, Arslanturk H. Typhoid intestinal perforation: Review of 11 cases. Epidemiol Infect. 2008; 136:436–81.

Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED. Part I analysis of data gaps Salmonella enteric serotype Typhi infection in low and medium human development index countries, 1984-2005. Epidemiol Infect. 2008 Apr; 136(4):436–48

Rowe B, Ward LR, Threlfall EJ. Multidrug-resistant Salmonella typhi a worldwide epidemic. Clin Infect Dis. 1997; 24:S106–9.

Gibney EJ. Typhoid perforation. Br J Surg. 1989; 76(9):887– 9.

Sitaram V, Moses BV, Fenn AS, Khanduri P. Typhoid ileal perforations: A retrospective study. Annals of the Royal College of Surgeons of England. 1990; 72:347–9.

Kim J-P, et al. Management of ileal perforation due to typhoid fever. Ann Surg. 1975 Jan; 181(1):88–91.

Talwarr S, Sharma A, Mittala IND, Prasad P. Typhoid enteric perforation. Aust N Z J Surg. 1997; 67:351–3.

Ugochukwu AI, Amu OC, Nzegwu MA. Ileal perforation due to typhoid fever- Review of operative management and outcome in an urban centre in Nigeria. International Journal of Surgery. 2013; 11(2013):218–22.

Steven, et al. Prognostic factors in typhoid ileal perforation: A prospective study of 53 cases. J NatI Med Assoc. 2007; 99:1042–5.

Chalya, et al. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting. World Journal of Emergency Surgery. 2012; 7:4.

Mittal S, et al. A comparative study between the outcome of primary repair versus loop ileostomy in ileal perforation. Surgery Research and Practice. 2014; 2014(2014).

Chaudhary P, Nabi I, Ranjan G, et al. Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis. Ann Gastroent Hepato. 2014; 27:1–6.

Kouame J, Kouadio L, Turquin HT. Typhoid ileal perforation: Surgical experience of 64 cases. Acta chir belg. 2004; 104:445–7.

Nguyen, et al. A clinical, microbiological, and pathological study of intestinal perforation associated with typhoid fever. Clinical Infectious Diseases. 2004; 39:61–67.

Shaikh GS, Fatima S, Shaikh S. Typhoid ileal perforation: a surgical audit. RMJ. 2011; 36(1):22–5.

Santillana M. Surgical complications of typhoid fever: Enteric perforation. World J Surg. 1991; 15(2):170–5.