Typhoid ileal perforation: a two-year study at a tertiary care hospital of South India

Authors

  • Kishore Kumar Markapuram Department of Surgery, Narayana Medical College, Nellore, Andhra Pradesh, India
  • Ramalinga Reddy Rachamalla Department of Surgery, Narayana Medical College, Nellore, Andhra Pradesh, India
  • Sreeram Satish Department of Surgery, Narayana Medical College, Nellore, Andhra Pradesh, India
  • Jithendra Kandati Department of Microbiology, Narayana Medical College, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20182080

Keywords:

Perforation, Salmonella typhi, Surgical site infection, Typhoid fever

Abstract

Background: Typhoid fever is an acute febrile illness caused by gram negative bacilli, Salmonella enteritidis serovars typhi. The incidence of typhoid fever varies globally from 140 episodes per 10000-person years in Kolkata to 273 per 10000 in Delhi, India. The present study was done with an aim to assess the risk factors, complications and different surgical techniques in cases of typhoid ileal perforation. The study also identifies and focuses on the post-operative complications in cases of perforation due to typhoid fever.

Methods: A prospective study was conducted for a period of two years from June 2105 to May 2017 at a tertiary care hospital on all the cases admitted and operated for typhoid perforation. The data collected was analyzed using SPSS version 15.0 for windows 7.

Results: 104 cases with an incidence rate of 8.4% of perforation were included in the study. Males were majority and mean age of the study group was 21.8±10.1 years. The peak incidence of study group was 31-40 years and >60 years. Fever and abdominal pain (rebound tenderness) was the common sign and symptoms. Free fluid and air collection under the diaphragm was the commonest finding in radiographs and ultrasound. Majority of the cases had single perforation (84.62%) and ileum was the most common site of perforation (84.62%). Simple closure with double layering was the commonest surgical procedure performed and the incidence of post-operative complication was 36.5%. Overall mortality in the study was 3.8%. SSI was the commonest post-operative complication.

Conclusions: To conclude from our study, typhoid still remains as an endemic disease in spite of improved awareness and better sanitation facilities. Inadequate treatment, misdiagnosis and mismanagement of cases by non-medical practitioners at rural settings may increase the risk of complications

References

Ananthnarayanan R, Paniker CKJ. Enterobacteriaceae III: salmonella textbook of medical microbiology. 8th ed. Hyderabad; Universities Press; 2009;288-300.

Government of India. National health profile 2011. New Delhi; Ministry of Health and Family Welfare: 2012.

Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, Ramani E et al. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Health. 2014:2:e570-e80.

Pegues DA, Miller SI:Salmonella Species, Including Salmonella Typhi.InMandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Edited by: Mandell GL, Bennett JE, Dolin R. Philadelphia: Elsevier Churchill Livingstone; 2009:2287-903.

Crum NF: Current trends in typhoid fever. Curr Gastro Enterol Rep. 2003;5:279-86.

Hosoglu S, Aldemir M, Akalin S, Geyik MF, Tacyildiz IH, Loeb M. Risk Factors for Enteric Perforation in Patients with Typhoid Fever. Am J Epidemiol 2004;160:46-50.

Agbakwuru EA, Adesunkanmi AR, Fadiora SO, Olayinka OS, Aderonmu AO, Ogundoyin OO: A review of typhoid perforation in rural African hospital. West Afr J Med. 2003;22:22-5.

Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED: Part I Analysis of data gaps Salmonella enteric serotype Typhi infection in low and medium human development index countries, 1984-2005. Epidemiol Infect. 2008;136:436-48.

National Enteric Disease Surveillance – CDC available at http://www.cdc.gov/ncezid/dfwed/PDFs/typhi_surveillance_overview_508c.pdf.

Sharma A, Sharma R, Sharma S, Sharma A, Soni D. Typhoid Intestinal Perforation: 24 Perforations in One Patient. Ann Med Health Sci Res. 2013;3:S41-3.

Pujar A, Ashok AC, Rudresh HK, Srikantaiah HC, Girish KS, Suhas KR. Mortality in Typhoid Intestinal Perforation–A Declining Trend. J Clinic Diagno Res: JCDR. 2013;7:1946-8.

Agu K, Nzegwu M, Obi E. Prevalence, Morbidity, and Mortality Patterns of Typhoid Ileal Perforation as Seen at the University of Nigeria Teaching Hospital Enugu Nigeria: An 8-year Review. World J Surg. 2014;38:2514-8.

Adesunkanmi AR, Ajao OG. The prognostic factors in typhoid ileal perforation: a prospective study of 50 patients. J R Coll Surg Edinb. 1997;42:395-9.

Yaramis A, Yildirim I, Katar S, Ozbek MN, Yalçin I, Tas MA, et al. Clinical and laboratory presentation of typhoid fever. Int Pediatr 2001;16:227-31.

Adesunkanmi ARK, Ajao OG: Prognostic factors in typhoid ileal perforation: a prospective study in 50 patients. J R Coll Surg Edinb. 1997,42:395-9.

Beniwal US, Jindal D, Sharma J, Jain S, Shyman G: Comparative study of operative procedures in typhoid perforation. Indian J Surg. 2003;65:172-7.

Agrawal V, Joshi MK, Gupta AK, Jain BK. Wound Outcome Following Primary and Delayed Primary Skin Closure Techniques After Laparotomy for Non-Traumatic Ileal Perforation: a Randomized Clinical Trial. Ind J Surg. 2017; 79:124-30.

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Published

2018-05-24

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Original Research Articles