Bashir Ahmad, Anjum Mehdi, Fakhar Q Hameed, Riaz Hussain Dab.
Evaluation and Determination of Prognostic Factors in Typhoid Ileal Perforation.
Annals Punjab Med Coll Jan ;3(2):107-13.

Objective: To determine the prognostic factors of typhoid ileal perforation. Study Design: A prospective study. Place and duration of study: The study was conducted in the departments of A&E and surgery at Allied Hospital Faisalabad, from September 1st, 2008 to August 31st, 2009. Patients and methods: With informed consent, the study was conducted on 56 patients who underwent laparotomy for peritonitis due to typhoid ileal perforation as per inclusion and exclusion criteria.The ileal perforations were managed by either primary simple transverse closure or primary defunctioning loop ileostomy. The prognostic evaluation was assessed by the impact of pre operative prognostic factors and per operative findings on post operative complications and mortality. For statistical significance, the data was analyzed by SPSS. Results: Among the total 56 patients, thirty four (61%) patients were managed by primary simple transverse closure while 22 (39%) patients had primary defunctioning loop ileostomy. The age and sex had no effect on the prognosis of typhoid ileal perforation. Mortality rate was 5.4%. Different post operative complications and their rates were burst abdomen 23%, residual intra abdominal abscess 16%, fecal fistula 7% and septicemia 5.4%.  Twenty eight (50%) patients developed wound infection which reflected only morbidity. Mortality remained nil in all those cases who had early presentation, admission-operation interval shorter than 12hours, size of perforation less than 1cm, amount of pus/fecal fluid less than1000ml and had primary simple closure. Three mortalities (5.4%) occurred among the cases with primary loop ileostomy due to a significant impact of pre operative and per operative prognostic factors on post operative complications and had a significant association with late presentation, admission-operation interval longer than 12hours, multiple perforations with size more than 1cm, amount of pus/fecal fluid greater than 1000ml. Conclusion: Late presentation, longer admission-operation interval, multiple perforations, size of perforations more than 1 cm and massive amount of intra peritoneal feco-purulent fluid significantly and adversely affect the prognosis of typhoid ileal perforation irrespective the surgical procedure used to manage the perforation.

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