Clinical study of typhoid ileal perforation and determination of preferred operative procedure in its management in Gandhi medical college and associated Hamidia hospital of Madhya Pradesh, India
DOI:
https://doi.org/10.18203/2349-2902.isj20175505Keywords:
Ileal perforation, Peritonitis, TyphoidAbstract
Background: To analyze clinical and operative findings in typhoid ileal perforation and determining preferred operative procedure.
Methods: All clinically suspected typhoid ileal perforation is classified into three categories depending on history, clinical and intraoperative findings (CAT I, CAT II, CAT III). All patients undergone surgical repair. Patient outcome in terms of complications, morbidity and mortality were compared to define the best procedure for Typhoid ileal perforation
Results: Out of 105 patients, majorities were less than 30 years and were males (4:1). Most common presentation being pain abdomen (100%), followed by fever (85.71%) while signs of peritonitis are present in all patients (100%) and majority patients had septicemia (77.14%) (TLC count >11,000 or <4,000) on presentation. 82 (78.09%) patients were Widal positive. Among CAT I (n=47), majority require primary repair (n=27; 57.44%) followed by resection anastomosis (n=14; 29.78%) and ileostomy (n=5; 10.63%) while among CAT II (n=38), majority require ileostomy (n=12; 31.57%) followed by resection anastomosis (n=5; 13.5%), whereas in CAT III (n=20), most patients require Ileostomy (n=14; 70%). Overall complications are more with CAT III (n=12; 60%) compared to CAT I (n=08; 17%) and CAT II (n=10; 26.31%) (p<0.001). Wound infection being most common complication (n=24; 22.85%), while fecal fistula more common with resection anastomosis (n=5; 21.73%) followed by primary repair (n=7; 14.89%). Mortality maximum with CAT III patients (n=6; 30%) (p<0.05). Stoma related complications mostly seen in CAT III. Among CAT II, two patients (5.2%) develop intra-abdominal abscess and two patients (5.2%) undergone stoma revision.
Conclusions: Primary repair and resection anastomosis are safer in CAT I while ileostomy is safer surgery in CAT III and CAT II. Resection anastomosis should be avoided in higher categories in fear of fecal fistula and related complications.
References
Kim JP, Oh SK, Jarret F. Management of ideal perforation due to typhoid fever. Ann surg. 1975;181:88-91.
Huckstep RL. Recent advanced in surgery of typhoid fever. Ann Roy Coll Surg Engl. 1960;26:207-80 .
Singh J, Singh B. Enteric perforation in typhoid fever, a study of 15 cases. Aust N Z J surg. 1975;45:279-84.
Bhansali SK. Gastrointestinal perforation; a clinical study of 96 cases. J Post Grad Med. 1967;13:1.
Singh S, Singh K, Grover AS, Kumar P, Singh G, Gupta DK. Two-layer closure of typhoid ileal perforations: a prospective study of 46 cases. Br J Surg. 1995;82(9):1253.
Eggleston EC, Santoshi B, Singh C M. Typhoid perforation of the bowel. Ann Surg. 1979;190:3-35.
Vyas PN. Study of 15 cases of intestinal perforation in enteric fever. Indian J Surg. 1964;26:1-8.
Singh KP, Singh K, Kohli JS. Choice of surgical procedure in typhoid perforation: Experience in 42 cases. J Indian Med Assoc. 1991;89:255-6.
Olurin EO, Ajavi OO, Bohrer SP. Typhoid perforations. J Roy Coll Surg Edinb. 1972;17:353-63.
Bailiga AV. Surgical complications of typhoid. Indian J Surg. 1949;11:166-77.
Swadia ND, Trivedi PM, Thakkar AM. Problem of enteric ileal perforation. Indian J Surg. 1979;41:643-51.
Adesunkanmi ARK, Ajao OG. Prognostic factors in Typhoid ileal perforation: a prospective study in 50 patients.’ R Coll Surg Edinb. 1997;42:395-9.
Porwal Sanjay kumar, Mewara B.C., Madhusudan and Gupta sanjeev; A clinical study of enteric perforation peritonitis. World J Surg. 1991;15(2):170-5.
Adesunkanmi ARK, Badmas TA, Fadiora FO. Generalised peritonitis secondary to typhoid ileal perforation: assessment of severity using modified APACHE II score. Indian J Surg. 2005;67:29-33.
Patterson FD. The surgical treatment of perforations of intestines in Typhoid fever: a review of the literature. Am J Med Sci. 1909;137:660-66.
Dickson JA, Cole GJ. Perforation of the terminal ileum. A review of 38 cases. Br J Surg. 1964;51:893-7.
Chatterjee H, Jagdish S, Pai D, Satish N, Jayadev D, Reddy PS. Changing trends in outcome of typhoid ileal perforations over three decades in Pondicherry. Trop Gastroentoral. 2001;22(3):155-8.
Khan SH, Aziz SA, Ul-Haq MI. Perforated peptic ulcers: A review of 36 Cases. Professional Med J. 2011;18(1):124-7.
Lee CW, Yip AW, Lam KH. Pneumogastrogram in the diagnosis of Perforated peptic ulcer. Aust N Z J Surg. 1993;63:459-61.
Chen SC, Yen ZS, Wang HP, Lin FY, Hsu CY, Chen WJ. Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitonium. Br J Surg. 2002;89:351-4.
Santillana M. Surgical complications of typhoid fever: enteric perforation. World J Surg. 1991;15(2):170-5.
Kaul BK. Operative management of typhoid perforation in children. Int Surg. 1975;60(8):407-10.
Vaidyanathan S. Surgical management of typhoid ileal perforation. Ind J Surg. 1986;335-41.
Purohit PG. Surgical treatment of typhoid perforations: Experience of 1976 Sangli epidemic. Indian J Surg. 1978;40(5):227-38.
Beniwal US, Jindal D, Sharma J, Jain S, Shyam G. Comparative study of operative procedures in typhoid perforation. Indian J Surg. 2003;65(2):172-77.
Talwar S, Sharma RK, Mittal DK, Prasad P. Typhoid enteric perforation. Aust N Z J Surg. 1997;67:351-3.
Shah AA, Wani KA, Wazir BS. The ideal treatment of enteric perforation. Int Surg. 1999;84(1):35-8.