Waseem Haider, Abdul Majid, Andaleeb Khanum, Amir Bhutta.
The prognostic factors in Typhoid Ileal Perforation.
Pak Postgrad Med J Jan ;13(1):4-8.

There are about 200 Salmonella serotypes mostly originating in animals and transmitted to men. The exception is Salmonella Typhi which invariably has a human source, and is transmitted through foecal-oral route, where sanitation is primitive. After a few days of bacteremia, the bacilli localize mainly in the lymphoid tissue of the small intestine, typical in the Peyer’s patches and follicles. They swell at first, ulcerate and ultimate heal, but during the sequence may perforate and bleed. So typhoid ileal perforation is still very common in the tropics, with high morbidity and mortality. To determine the prognostic factors in typhoid ileal perforation, a prospective study was carried out in 50 patients. The sex ratio was 4:1 in favour of male, with an age range of 7-42 years and a mean of 19.5 years. The age and sex and no effect on the prognosis. Late presentation, delay in operation, multiple perforations, and drainage of copious quantities of pus and faecal material from the peritoneal cavity adversely affected the incidence of faecal fistula and the mortality rate. The development of faecal fistula significantly affected the mortality rate. Fourteen patients (28%) died. 50% of these within the first 5 post-operative days. (50% + 21) of the 14 died within 10 days. Thus, surviving for more than 10 post-operative days tends to give a better chance of recovery. In conclusion, this study has been attempted to outline those factors with a strong effect on the progression and outcome of Typhoid ileal perforation in Pakistani patients.

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