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Typhoid enteric perforation

Y Akgun¹, B Bac, S Boylu

¹Dicle University School of Medicine, Department of General Surgery, Diyarbakir, Turkey.

The British Journal of Surgery

|November 1, 1995

Summary

Aggressive resuscitation and combined antibiotics significantly reduced complications and deaths from typhoid enteric perforation. This improved treatment strategy also shortened hospital stays for patients.

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Area of Science:

Gastroenterology
Infectious Diseases
Surgical Outcomes

Background:

Typhoid enteric perforation is a severe complication of Salmonella Typhi infection.
Previous treatment strategies had high morbidity and mortality rates.

Purpose of the Study:

To identify prognostic indices and therapeutic options for typhoid enteric perforation.
To evaluate the impact of an aggressive preoperative and postoperative management protocol on patient outcomes.

Main Methods:

Retrospective review of 267 cases to identify prognostic factors.
Prospective study of 39 patients treated with aggressive resuscitation, combined antibiotics (chloramphenicol, ampicillin/sulbactam, ornidazole), and total parenteral nutrition.

Main Results:

Initial retrospective review showed 55.4% morbidity and 28.5% mortality.
The prospective protocol reduced morbidity to 25% and mortality to 10%.
Median hospitalization decreased from 18 to 12 days.

Conclusions:

Aggressive preoperative resuscitation and combined antibiotic therapy are crucial.
Selected operative procedures and metabolic support (total parenteral nutrition) improve outcomes.
This comprehensive approach significantly decreases morbidity and mortality in typhoid enteric perforation.

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