Khalid Shahzad, Irfan Akhtar, Asim Ijaz, M Mussadiq Khan.
Outcome of Ileostomy in Cases of Typhoid Perforation Presenting After 48 Hours
J Rawal Med Coll Dec 2000;4(1-2):17-9.
Department of Surgery Unit I, Holy Family Hospital, Rawalpindi

Introduction: Typhoid fever is a febrile illness caused by S.typhi, that results from dissemination of organisms from the gut lymphoid tissue into blood stream and is characterized by prolonged remittent fever, rash, (rose spots), splenomegaly, lymphadenopathy, leucopoenia and generalized complications. Typhoid fever is still a major health problem in developing parts of world, with an estimated annual incidence of 540/100,000. One of the most lethal complications of typhoid fever is intestinal perforation. In a review of literature, VanBasten-JP and Stockenbrugger-R found the incidence of intestinal perforation to be 3% with an overall mortality of 39.6% in 66,157 patients with typhoid fever. There are different modes of treatment for typhoid perforation currently in practice. 1. Primary closure of perforation either in single layer or double layer, 2. Resection Anastamosis, 3. End-Ileostomy & Mucous Fistulae. (With or without resection), 4. Tube Ileostomy. All these modalities are currently in practice in different groups of patients. But the morbidity and mortality remains high particularly in those patients in whom surgical intervention is carried out more than 48 hours of estimated time of perforation. So, the issue remains controversial about ideal treatment in patients with typhoid perforation presenting 48 hours after their initial signs and symptoms of perforation. Study: Typhoid perforation of small intestine is common in our country and quite a few patients present late. This prospective study was carried out in Holy Family Hospital from January 1996 to August 1996. Fifty patients of typhoid perforation who presented after 48 hrs in emergency room were included in this study. Ileostomy was done in all cases. Results were compared with published data. It was observed that ileostomy is better option than primary closure in these cases.

Category: Surgery
Keywords: Ileostomy. Typhoid Perforation. Typhoid. Salmonella.

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