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Aggressive fluid resuscitation and broad spectrum antibiotics decrease mortality from typhoid ileal perforation

C Mock1, L Visser, D Denno

  • 1Holy Family Hospital, Berekum, Ghana.

Tropical Doctor
|July 1, 1995
PubMed
Summary
This summary is machine-generated.

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Improving surgical techniques and antibiotic regimens for typhoid ileal perforation significantly reduces mortality rates in resource-limited settings. Enhanced fluid resuscitation and broader-spectrum antibiotics are key to better patient outcomes.

Area of Science:

  • Tropical Medicine
  • Surgical Gastroenterology
  • Infectious Diseases

Background:

  • Typhoid enteritis can lead to severe ileal perforations, with high mortality in endemic areas due to limited supportive care.
  • Rural African hospitals face challenges in managing complications like typhoid ileal perforation.

Purpose of the Study:

  • To evaluate the impact of surgical technique and antibiotic choice on mortality from typhoid ileal perforation.
  • To assess the effect of intraoperative fluid administration volume on early and late mortality.

Main Methods:

  • A retrospective study comparing mortality rates based on surgical closure methods (one-layer vs. two-layer) and antibiotic regimens.
  • Analysis of mortality rates correlated with different volumes of intraoperative fluid administration (<10 ml/kg vs. >10 ml/kg).

Related Experiment Videos

Main Results:

  • Two-layer closure with chloramphenicol, gentamicin, and metronidazole reduced overall mortality from 40% to 19%, primarily decreasing late mortality.
  • Aggressive intraoperative fluid resuscitation (>10 ml/kg) decreased overall mortality from 43% to 14%, mainly reducing early mortality.

Conclusions:

  • Broader spectrum antibiotics and two-layer closure effectively decrease late mortality in typhoid ileal perforation.
  • Increased intraoperative fluid resuscitation is crucial for reducing early mortality in these cases, even in resource-limited settings.