Management of Typhoid Ileal Perforation: A Surgical Experience of 28 Cases

Hassan Salman, Amer; Abd Al-Badri, Jasem

	Management of Typhoid Ileal Perforation: A Surgical Experience of 28 Cases
IRAQI JOURNALOF COMMUNITY MEDICINE
Article 1, Volume 24, Issue 4, 2011, Pages 343-348
Authors
Amer Hassan Salman; Jasem Abd Al-Badri
Abstract
Background: Typhoid fever is an endemic disease in Iraq. Many patients presented with an acute surgical abdomen due to ileal perforation which is a serious complication of Typhoid fever The outcome of management is determined by the promptness of the appropriate surgical operation. Objectives: Early surgical treatment of typhoid ileal perforation, decrease morbidity and mortality. Patients and Methods: Twenty eight Typhoid ileal perforation patients had been collected in AL-Kut General Hospital & Fourth surgical unit at Al-Yarmouk Teaching Hospital. Ten years period between Jan. 1999- Dec. 2008, all patients were admitted to the emergency room (E.R.) as acute abdomen. Typhoid ileal perforation expected clinically & proved by investigation such as plain abdominal x-ray, ultrasound & operative laparotomy findings. For patients who have single ileal perforation, wound debredement of the perforation edges and closed by single layer interrupted transverse suturing by vicryle 2/0. For patients with multiple ileal perforations, resection of the affected ileal part with end to end anastomosis, the excised tissue were send for histopathological examination. Irrigation of the abdominal cavity with Normal Saline and tube drains was used in all operations. Post-operative complications were studied. Results: 18 (64.3%) were males. 10 (35.7%) were females, age ranges (17-41), mean age (25.6).Step ladder fever, abdominal pain and distention were the most clinical manifestation in the majority of the patients. Constipation, vomiting and diarrhea, were in some other patients. Widal test titer more than 1/320 in 12 (42.8%) patients, plain abdominal x-rays were positive in 21 (75%) patients, abdominopelvic ultrasound, had been done in 11(39.3%), all of them showed free soiled pelvic collection. In exploratory laparotomy, 28 (100%) patients were found to have peritoneal cavity collection, in 23 (82 %) patients had single ileal perforation and 5 (18%) patients had multiple perforation. The site of perforation was within 10-50cm distance from the ileocaecal junction, mean distance 21cm. The postoperative complications were prolonged paralytic ileus (> 3days) 75%; wound infection 67.85%, wound dehiscence (21.4%), fecal fistula (10.7%) and residual abdominal abscesses (7.1%) and death (21.4%).Total postoperative complications were found in19 (67.85%) patients, and 9(32.14%) patients were free from postoperative complications. Postoperative complications were inversely related with the time of presentation (25%) in early hospital presentation (within 1 day) and 100% in late (> 5 days) hospital presentation. Conclusions: Typhoid ileal perforation is a serious complication, carries high risk of morbidity and mortality rate. Early surgical repair is the ideal treatment of typhoid ileal perforation. Resuscitation and surgical treatment, if carried within first 24 hours duration decrease morbidity and mortality rate. Keywords: Typhoid fever, ileal perforation, acute abdomen, postoperative complications.
Keywords
Typhoid fever; ileal perforation; acute abdomen; postoperative complications

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