Abstract

Dr. Parikh Choudhury* and Dr. Purujit Choudhury

ABSTRACT

Introduction and Aim: Intestine perforation is one of the most dreaded andcommon complication of typhoid fever remarkably so in developing world; itusually leads to diffuse peritonitis, requiring early surgical intervention. Despitevarious measures such as safe drinking water supply and safe disposal of waste,intestinal perforation from salmonellosis remains the most common emergencysurgery performed. The incidence continues to rise, so also the mortality, despitenew antibiotics and improvement in surgical technique. More disturbing is that wenow see increasing number of ileal perforations and colonic involvement. Typhoidfever is a systemic and severe febrile illness caused primarily by the gram negativebacillus Salmonella enteritidis serovar Typhi. Hence it is an infective disorderwith fatal outcome if the disease is not treated properly. The most lethalcomplication of it are bleeding and ileal perforation, both arising from necrosis ofPeyer’s patches in the terminal ileum. Complications are to be controlled as andwhen infection is cured. The aim of this study to know the best treatment protocolfor this emergency disease after a thorough genesis. Also to to show whether simplerepair of perforation is the justified surgical procedure in terms of morbidity,mortality and cost effectiveness. Materials and Methods: The present study wasconducted in 195 adult patients of Typhoid perforation admitted during 2014 to2018 and treated surgically at Gauhati Medical College. Double layer simpleclosure of perforation done in majority. In this study enteric perforation was morecommon in males than in females with a ratio of 6.8:1.Their ages ranges from 14 to65 years. Duration of perforation, number of perforation and development of faecalfistula are the factors which significantly affect mortality. Primary proximaltemporary ileostomy and ileo transverse anastomosis were performed in somepatients with multiple perforations and/or with perforation situated near/on theileocaecal junction having greater risk of “repair leak”. Resection and anastomosisis considered in some cases of multiple perforations and unhealthy gut with orwithout defunctioning ileostomy. Results: Common post-operative complicationsinclude wound infection (21%), bleeding (1.02%-2 cases out of 195), faecal fistula(1.9%)-4 cases out of 195 and skin excoriation around ileostomy (9.4%). Primaryclosure(two layer) of perforation satisfactory result in terms of complications andresection is preferred in selected patients. Conclusions: Ileal perforation followingtyphoid fever is not unusual. Resuscitation followed by emergency surgery is theappropriate to manage. Quinolone is the drug of choice. Usually two layer primaryclosure is the procedure of choice though resection and anastomosis is reserved forspecial situation. Prognosis is much better if appropriately managed.