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Typhoid ileal perforations: a retrospective study

V Sitaram1, B V Moses, A S Fenn

  • 1Department of Surgery, Christian Medical College and Hospital, Tamil Nadu, India.

Annals of the Royal College of Surgeons of England
|November 1, 1990
PubMed

Insights

This study on typhoid ileal perforation found that longer delays and multiple perforations worsened outcomes. Trimming the ulcer with closure significantly reduced mortality compared to simple closure.

Area of Science:

  • Surgery
  • Tropical Medicine
  • Gastroenterology

Background:

  • Typhoid ileal perforation is a serious complication of Salmonella Typhi infection.
  • Understanding prognostic factors is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify characteristics and prognostic determinants in patients with typhoid ileal perforation.
  • To compare the outcomes of different surgical management strategies.

Main Methods:

  • Retrospective analysis of 124 patients treated for typhoid ileal perforation over 17 years (ending 1986).
  • Identification of adverse prognostic factors including fever/perforation interval, perforation/operation interval, and number of perforations.
  • Comparison of mortality rates between simple closure and ulcer trimming with closure surgical techniques.

Main Results:

  • Three adverse prognostic determinants identified: prolonged fever/perforation interval, prolonged perforation/operation interval, and multiple perforations.
  • Simple closure in 74 patients resulted in a 31.1% mortality rate.
  • Trimming of the ulcer with closure in 38 patients showed a significantly lower mortality rate of 7.9%.

Conclusions:

  • Surgical timing and the extent of intestinal involvement are critical in typhoid ileal perforation.
  • Ulcer trimming with closure appears to be a superior surgical technique, reducing mortality.
  • Further research into optimal surgical management for typhoid ileal perforation is warranted.

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