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Typhoid perforation of the ileum in children
Insights
This study compared two ileum bypass methods for typhoid perforation in children. Temporary total ileum bypass showed lower mortality and fewer complications than partial bypass.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Infectious Disease Management
Background:
- Typhoid perforation of the ileum is a serious complication in children.
- Surgical intervention is often required, with varying outcomes.
- Optimizing surgical techniques and supportive care is crucial for improving survival rates.
Purpose of the Study:
- To compare the outcomes of two surgical protocols for typhoid ileum perforation in pediatric patients.
- To evaluate the efficacy of temporary total ileum bypass versus partial ileum bypass.
- To analyze complication rates and mortality associated with each surgical approach.
Main Methods:
- Prospective study of 59 children with typhoid ileum perforation.
- Protocol 1: Temporary total ileum bypass (end-to-side ileotransverse colostomy) followed by intestinal continuity restoration.
- Protocol 2: Partial ileum bypass (one-stage lateral tube ileostomy).
Main Results:
- The total bypass group (36 cases) had a mortality rate of 27.7% with no reperforations or fistulae.
- The partial bypass group (23 cases) had a mortality rate of 34.8%, with one reperforation and four fistulae.
- Combined mortality across both groups was 30.5%.
Conclusions:
- Temporary total ileum bypass appears to offer better outcomes with reduced complications compared to partial bypass.
- Improved results may be achieved with bypass surgery combined with comprehensive medical supportive treatment, including total parenteral nutrition.
- Further research into optimizing surgical and supportive care for typhoid perforation is warranted.
Abstract:
Since 1974, 59 children with typhoid perforation of the ileum were studied prospectively using two protocols. In the first 36 cases a temporary total bypass of the terminal ileum was done (end-to-side ileotransverse colostomy) and several weeks later the intestinal continuity was restored (end-to-end ileoileostomy). The second protocol consisted, in 23 cases, of a partial bypass of the terminal ileum (one stage lateral tube ileostomy). Of the first group 10 died (27.7%). There was no reperforations or fistulae in this group. Of the 26 lateral tube ileostomies 8 died (34.8%). There was one reperforation and 4 fistula in this group. The combined mortality was 30.5%. Complications are presented as well as different methods of treatment. The author believes that a bypass operation with good medical supportive treatment, including total parenteral alimentation, will improve results.