ILEAL PERFORATIONS

A REVIEW OF 74 CASES

Abstract

Typhoid fever is a major global health problem but enteric complications of typhoid fever are a major health hazards in the tropics. Though it affects many organ systems, intestinal perforation or GI hemorrhage are the major causes of fatality. OBJECTIVES: To point out the preventable aspects of the disease as to find out mortality and morbidity associated with it. To compare the results of various surgical choices. DESIGN: Prospective study. PATIENTS & METHODS: Records of 74 patients admitted to one surgical unit of DMCH during the period of January 1995 to December 1997 were reviewed. In 59 (79.73%) a final diagnosis of typhoid perforation were made on clinical ground supported by laboratory and radiological data. Histological examination of ulcer margins were done in all 74 cases but of lymph nodes on by occasionally. RESULTS: 30 patients (about 50%) reported between 3rd to 7th day of onset of pain and distension of abdomen. 32 patients reported 2 months after the initial symptoms. The diagnosis of perforation due to typhoid ulcer was in 59 patients (79.73%), tubercular ulcer in 8 patients (10.8%), Crohn’s disease in 6 patients (8.1%), and traumatic rupture in one (1.3%). Fever and diffuse abdominal pain were common symptoms. X-ray evidence of pneumo-peritoneum was positive in 35 patients (47.3%). Only 31 patients (41.9%) showed un-eventful recovery. Others suffered from wound complications like hematoma, sepsis1, discharge (4 patients), fecal fistula (2patients), wound disruption (16patients), death (3patients). CONCLUSIONS & SUGGESTIONS: Late presentation to the hospital was directly related to the post-operative mortality and morbidity. Early identification and referral to hospital is likely to reduce mortality and morbidity significantly.