Results of typhoid perforation management: our experience in Bir Hospital, Nepal

To determine the demographic characteristics, clinical features, operative findings and postoperative complications in patients operated for typhoid enteric perforation.

A retrospective study was carried out in the Department of General Surgery, Bir Hospital since 2002 to April 2004. Among 189 patients who underwent laparotomy for hollow viscus perforation in two years, ileal perforation was found in 102 patients.

The sex ratio of the patients was 4.66:1, in favor of male, with age range of 14-78 years and mean age 28.35 years. Most of the patients (80.39 %) presented with history of fever for two weeks. Half of the patients presented within 24 hours of onset of generalized abdominal pain. Majority (65.67%) had a solitary perforation on the antimesenteric border of terminal ileum. Eighty one percent of patients had trimming of the ulcer margins and primary closure. Complications included wound infection (35.3%), wound dehiscence (17.6%), fecal fistula (7.84%) and hospital mortality (6.86%).

Typhoid ulcer perforation is common among developing nations, including Nepal. Postoperative complications following surgical management of perforation are high and increases mortality.