Umer Farooq, Sumaiya Farooq, Sana Zahir, Abdul Majeed Chaudhry.
Risk factors of typhoid ileal perforation.
Pak J Med Health Sci Jan ;6(1):69-74.

Objective: To determine the risk factors for typhoid Ileal perforations in cases of typhoid fever so that by the advocacy of those factors we can reduce the rate of perforations and hence the mortality and morbidity in cases of typhoid fever. Study design: Observational & Descriptive Place and duration: The study was carried out in the department of surgery, Sir Ganga Ram Hospital, Lahore, from 20-08-2007 to 19-08-2009 Sample size: 50 patients of Enteric perforation of Typhoid Fever. Materials and methods: All patients were treated as a surgical emergency. Broad spectrum antibiotic (Ceftriaxone & Metronidazole) coverage, nasogastric suction, correction of fluid, electrolyte balance and anaemia done to all patients preoperatively. Exploratory laparotomy done under General Anaestheisa. Operative procedure was decided on the basis of operative findings. Postoperatively the patients were followed up for any complication like feacal fistula. Parenteral antibiotics were continued for at least 5 days. All the data were recorded on a pre-designed proforma. The data was entered and evaluated in statistical program SPSS version 16.0. Results: Fifty cases of ileal perforation were enrolled in this study based on inclusion and exclusion criteria. The mean age±SD (range) was 25.0±12.70 years (7 to 55 years). Majority of cases 38 (76.0%) were between 13 to 45 years of age, 40 (80.0%) were males and 10(20.0%) were females. 100% patients presented with abdominal pain, 100% with history of fever, 100 with distention alongwith constipation. In 9(18.0%) patients perforations, after freshening the ulcer were closed by single layered interrupted extra-mucosal technique with vicryl 2/0 and in remaining 41(82.0%) patients loop ileostomy was made. Wound infection was present in 33(66.0%) patients, wound dehiscence in 17(34.0%), Stenosis in 3(6.0%), herniation in 5(10.0%), intra abdominal abscess in 5(10.0%) and septicemia was found in 4(8.0%). Procedure of primary repair was performed in 18(36.0%) patients, segmentation resection and end to end anastomosis procedure was done in 4(8.0%) cases and primary repair with proximal ileosotomy was performed in 28(56%) patients. Conclusion: Typhoid fever and its complications remained an important cause of deaths in poor resources countries due to lack of proper health education. A short duration of symptom, leucopenia, inadequate treatment and male gender are independent risk factor of perforation.

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