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[Typhus perforation in the tropics. Apropos of 83 cases]
1Service de Chirurgie Générale, Hôpital Angiang, Viet Nam.
Abstract:
Peritonitis due to typhus is still frequent in Vietnam. We studied retrospectively 83 cases of 83 patients operated for peritoneal perforations due to typhus between January 1986 and December 1987. There were more males than females (56 versus 27) and most of the patients were under 30 years of age (72.2%). The diagnosis was made on the basis of clinical picture of fever associated with peritonitis and ileal lesions seen at laparotomy. Treatment for most patients included surgical exeresis, suture of the perforation and lavage and draining of the abdominal cavity. Fifteen patients died during the perioperative period (18% operative mortality). There were 76 cases of post-operative complications involving 55 patients. The most frequent complication was parietal infection observed in 55 cases (66.3%). The most severe complication was suture failure seen in 5 cases, 4 of which had a fatal outcome. Operative delay was a statistically significant factor of prognosis. In the specific situation of our clinical experience, simple suture or suture excision remain the most adapted and effective modes of treatment.
Insights
Typhus-related peritonitis in Vietnam frequently requires surgery. Simple suture or suture excision of ileal perforations are effective treatments, with operative delay significantly impacting prognosis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Context:
- Peritonitis resulting from typhus remains a significant clinical challenge in Vietnam.
- This retrospective study analyzes 83 cases of peritoneal perforations due to typhus treated surgically between 1986 and 1987.
Purpose:
- To evaluate the diagnostic criteria, treatment modalities, and outcomes of typhus-related peritonitis.
- To identify prognostic factors and assess the efficacy of surgical interventions.
Summary:
- The study involved 83 patients, predominantly males under 30, diagnosed via clinical presentation and laparotomy findings of ileal lesions.
- Treatment involved surgical exeresis, perforation repair, and abdominal lavage; 18% operative mortality was observed.
- Post-operative complications, notably parietal infection (66.3%) and suture failure (5 cases, 4 fatal), were frequent. Operative delay was a key prognostic factor.
Impact:
- Highlights the high morbidity and mortality associated with typhus-induced peritonitis.
- Emphasizes the effectiveness of simple suture or suture excision for ileal perforations in this context.
- Underscores the critical importance of minimizing operative delay for improved patient outcomes.