DOI: http://dx.doi.org/10.18203/2349-2902.isj20195179

Our experience with enteric ileal perforation: a retrospective study at a tertiary care centre in northern India

Puneet Agrawal, M. Zaid Imbisat

Abstract


Background: Typhoid fever is one of major causes of intestinal perforation in India and is one of the common surgical emergencies for which intervention is required. The study aims to evaluate the clinical presentation, operative findings, outcome of surgical procedures, postoperative complications and associated mortality among the patients managed for typhoid ileal perforation in a tertiary care hospital.

Methods: This was a retrospective study evaluating the patients who were operated for typhoid ileal perforation peritonitis in FH Medical College, Agra, UP, India between April 2017 and September 2019. Diagnosis of typhoid ileal perforation was made with the combination of clinical presentation, laboratory investigations, radiological results and per-operative findings.

Results: In the present study, 57 patients were managed for typhoid ileal perforation. Majority of the patients were young. In our study 40 patients (70.18%) were male and 17 patients (29.82%) were female. All patients presented with pain in abdomen and abdominal distension. However there was no history of fever in 19.3% of patients. Free gas under the right diaphragm was present in 60% of patients. Exploratory laparotomy was done in all the patients and multiple perforations were found in 59.65% of patients. Ileostomy was made in 75% of patients. Most common post-operative complication was wound infection (85.96%) and mortality was 12.28%.

Conclusions: Perforation peritonitis is an alarming complication of typhoid fever which needs urgent and aggressive management. Mortality rate is high (12.28%) and may be attributed to delayed presentation.


Keywords


Typhoid fever, Ileal perforation, Ileostomy, Complications

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References


John J, van Aart CJC, Grassly NC. The Burden of typhoid and paratyphoid in india: systematic review and metaanalysis. PLoS Negl Trop Dis. 2016;10(4):e0004616.

Buckle GC, Walker CL, Black RE. Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010. J Glob Health. 2012;2:010401.

Contini S. Typhoid intestinal perforation in developing countries: still unavoidable deaths?. World J Gastroenterol. 2017;23(11):1925-31.

Ahmad T, Khan MI, Hussain N, Siddiqui E, Islam ZU. Perforation operation interval as a prognostic factor in typhoid ileal perforation. J Surg Pak. 2009;14:11 4.

Sheshe AA, Anyanwu LJC, Mohammad AM, Muhammad AB, Obaro SK. Typhoid intestinal perforation: Analysis of the outcome of surgical treatment in Kano, Nigeria. Arch Med Health Sci. 2018;6:59-63.

Jhobta RS, Attri AK, Kaushik R, Sharma R, Jhobta A. Spectrum of perforation peritonitis in India-review of 504 consecutive cases. World J Emerg Surg. 2006;1:26.

Bosscha K, van Vroonhoven TJ, Werken C. Surgical management of severe secondary peritonitis. Br J Surg. 1999;86(11):1371-7.

Ukwenya AY, Ahmed A, Garba ES. Progress in management of typhoid perforation. Ann Afr Med. 2000;10:259-65.

Suanes C, Salvesan H, Espehang B. A multifactorial analysis of factors related to lethality after treatment of perforated gastrduodenal ulcer. Ann Surg. 1989;209:418-23.

Bhansali SK. Gastrointestinal perforation: a clinical study of 96 cases. J Postgraduate Med. 1967;13(1):1-12.

Archampong EQ. Operative treatment of typhoid perforation of the bowel. Br Med J. 1969;3:273.

Chalya PL, Mabula JB, Koy M, Kataraihya JB, Jaka H, Mshana SE, et al. Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: a surgical experience of 104 cases in a resource-limited setting. World J Emerg Surg. 2012;7:4.

Pujar KA, Ashok AC, Rudresh HK, Srikantaiah HC, Girish KS, Suhas KR. Mortality in typhoid intestinal perforation-a declining trend. J Clin Diagn Res. 2013;7(9):1946-48.

Olurin EO, Ajavi OO, Bohrer SP. Typhoid perforation. J Royal College of Surgeons of Edinburgh. 1972;17:353.

van Basten JP, Stockenbrugger R. Typhoid perforation. A review of the literature since 1960. Trop Geogr Med. 1994;46:336-9.

Mohil RS, Singh T, Arya S, Bhatnagar D. Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation. Patient Saf Surg. 2008;2:31.

Osifo OD, Ogiemwonyi SO. Typhoid ilial perforation in children in Benin city. Afr J Paediatr Surg. 2010;7:96-100.

Atamanalp SS, Aydinli B, Ozturk G, Oren D, Basoglu M, Yildirgan MI. Typhoid intestinal perforations: twenty-six year experience. World J Surg. 2007;31:1883-8.

Agbakwuru EA, Adesunkanmi AR, Fadiora SO, Olayinka OS, Aderonmu AO, Ogundoyin OO. A review of typhoid perforation in a rural African hospital. West Afr J Med. 2003;22(1):22-5.

Nuhu A, Dahwa S, Hamza A. Operative management of typhoid ileal perforation in children. Afr J Paediatr Surg. 2010;7:9-13.

Ekenze SO, Okoro PE, Amah CC, Ezike HA, Ikefuna AN. Typhoid ileal perforation: analysis of morbidity and mortality in 89 children. Niger J Clin Pract. 2008;11:58-62.

Saxe JM, Cropsey R. Is operative management effective in treatment of perforated typhoid? Am J Surg. 2005;189:342-4.

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.

Abantanga FA, Nimako B, Amoah M. The range of abdominal surgical emergencies in children older than 1 year at the Komfo Anokye teaching hospital, Kumasi, Ghana. Ann Afr Med. 2009;8:236-42.

Akgun Y, Bac B, Boylu S, Aban N, Tacyildiz I. Typhoid enteric perforation. Br J Surg. 1995;82:1512-5.

Adesunkanmi AR, Oseni SA, Adejuyigbe O, Agbakwuru EA. Acute generalized peritonitis in African children: assessment of severity of illness using modified APACHE II score. ANZ J Surg. 2003;73:275-9.

Meier DE, Tarpley JL. Typhoid intestinal perforations in Nigerian children. World J Surg. 1998;22:319-23.

Edino ST, Mohammed AZ, Uba AF, Sheshe AA, Anumah M, Ochicha O, Yakubu AA, Alhassan SU, Mamman M et al. Typhoid enteric perforation in North Western Nigeria. Nig J Med. 2004;13:345-9.

Ansari AG, Naqvi SQH, Ghumro AA, Jamali AH, Talpur AA. Management of typhoid ileal perforation: a surgical experience of 44 cases. Gomal J Med Sci. 2009;7(1):27-30.

Bhopal FG, Azhar F, Fatima T. Selective management of typhoid perforation of Bowel. J Surg Pak (Int). 2011;16(3):123-6.