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Typhoid enteric perforations
Abstract:
Forty-five cases of typhoid enteric perforation are presented. The disease was most common in young males. Half of the perforations occurred during the second week of fever. Diagnosis was mainly clinical, supplemented by radiological evidence of pneumoperitoneum and confirmed at laparotomy by the presence of perforations in the terminal ileum. Laboratory investigations including Widal perforations in the terminal ileum. Laboratory investigations including Widal test and blood culture were of little value. All the 45 were managed operatively by simple closure of the perforation(s) and drainage of the peritoneal cavity. Burst abdomen occurred in 9 per cent and fecal fistula in 20 per cent. Overall mortality was 11 per cent--much lower than that reported in the literature in case of management of typhoid enteric perforations.
Insights
Typhoid enteric perforation, common in young males, was diagnosed clinically with radiological support. Simple surgical closure and drainage led to an 11% mortality rate, lower than previously reported.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Infectious Diseases
Background:
- Typhoid enteric perforation is a severe complication of Salmonella Typhi infection.
- Early diagnosis and effective management are crucial for improving patient outcomes.
- Previous studies report high mortality rates associated with typhoid perforation.
Purpose of the Study:
- To present the clinical features, diagnostic methods, and surgical management of typhoid enteric perforations.
- To evaluate the outcomes and mortality associated with a specific surgical approach.
- To compare the findings with existing literature on typhoid perforation management.
Main Methods:
- Retrospective analysis of 45 cases of typhoid enteric perforation.
- Diagnosis based on clinical presentation, radiological evidence (pneumoperitoneum), and intraoperative findings (terminal ileum perforations).
- Surgical management involved simple closure of perforations and peritoneal drainage.
Main Results:
- The condition predominantly affected young males, with perforations often occurring in the second week of fever.
- Clinical diagnosis supplemented by pneumoperitoneum was key; Widal test and blood cultures showed limited utility.
- Postoperative complications included burst abdomen (9%) and fecal fistula (20%).
Conclusions:
- Simple closure and drainage offer a viable surgical strategy for typhoid enteric perforations.
- The observed 11% mortality rate is significantly lower than previously reported figures.
- This approach may contribute to reduced morbidity and mortality in managing this surgical emergency.