Is operative management effective in treatment of perforated typhoid?

Salmonella typhi infection continues to be a significant problem worldwide. Patients suffering from "typhoid" in endemic regions such as West Africa often present late in the course of the disease with symptoms of malnutrition and peritonitis. Clinical peritonitis in these patients is invariably associated with perforation of the terminal ileum and purulent peritonitis. Operative intervention and its success have not been well documented. The purpose of this article is to review the experience of 1 hospital in West Africa and the efficacy of operative management of perforated intestine from typhoid.

A retrospective review of all patients admitted between January and October of 2003 to the Carolyn Kempton Memorial Hospital in Togo, West Africa, with the diagnosis of typhoid. Demographic data including age, sex, number of perforations, and outcome were obtained. All patients were treated with ampicillin, gentamycin, and flagyl or chloramphenicol as the sole antibiotic therapy along with operative management.

One hundred ninety-one patients with typhoid were admitted. One hundred twelve patients underwent laparotomy for perforation, 18 of whom died from persistent typhoid septicemia for a mortality rate of 16%. Reoperative management was used in some patients who did not respond immediately.

Primary repair of typhoid perforation is a safe and effective treatment. Patients with persistent septicemia after laparotomy most likely have resistant Salmonella typhi infection. Availability of second-line antibiotic therapy in these third world countries would likely improve outcomes. Prospective studies on appropriate antibiotic therapy along with operative management in endemic areas are necessary until resources are available for preventative measures.