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Typhoid perforation: factors affecting mortality and morbidity
Abstract:
Thirty-six patients were operated upon for terminal ileal perforations in a two-year period; four cases were due to trauma, four to ascariasis and 28 to typhoid. Ileal perforations due to ascaris worms are differentiated from typhoid ileal perforations because worms are usually found lying freely in the peritoneal cavity or in close association with the perforations. Also, tests for Salmonellae and Shigella are usually negative. Factors affecting mortality and morbidity in typhoid ileal perforation include the age of the patient, duration of perforation before surgery, presence of additional complications, such as massive rectal bleeding, the extent of the surgery, and the number of perforations present. Chloramphenicol in massive doses is indicated for all these patients. Our experience suggests that the hematoxicity of this drug has been over-rated. Postoperative complications are: wound infection (about 95% of cases), malarial fever, septicemia, fecal fistula, intraabdominal abscess, pulmonary infection, jaundice and transient psychosis.
Insights
This study analyzed 36 ileal perforations, with typhoid being the most common cause. Typhoid ileal perforations require prompt surgical intervention and Chloramphenicol treatment, with manageable complications.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Terminal ileal perforations present a significant surgical challenge.
- Distinguishing between traumatic, parasitic (ascariasis), and infectious (typhoid) etiologies is crucial for appropriate management.
Purpose of the Study:
- To analyze the causes, clinical features, and outcomes of terminal ileal perforations.
- To evaluate the role of Chloramphenicol in managing typhoid ileal perforations.
Main Methods:
- Retrospective review of 36 patients undergoing surgery for terminal ileal perforations over two years.
- Clinical data including etiology, surgical findings, treatment, and postoperative outcomes were analyzed.
Main Results:
- Typhoid was the leading cause (28/36 cases), followed by trauma (4/36) and ascariasis (4/36).
- Mortality and morbidity in typhoid ileal perforation were associated with patient age, delay in surgery, complications like rectal bleeding, and surgical extent.
- Chloramphenicol, despite concerns of hematotoxicity, was deemed indicated and manageable.
Conclusions:
- Typhoid ileal perforation is a common surgical emergency requiring timely intervention.
- Aggressive antibiotic therapy with Chloramphenicol is essential, and its perceived toxicity may be overstated.
- Postoperative complications, though frequent, can be managed effectively.