Qasmi G, Majid H J, Harun Majid Dar, Arif Jared, Siddique Z, Tufail M.
Critical factors effecting morbidity and mortality in patients operated for typhoid ileal perforation.
Proceeding Shaikh Zayed Postgrad Med Inst Jan ;19(1):25-31.

Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with a significant morbidity and mortality. To determine the factors affecting morbidity and mortality in patients with typhoid intestinal perforation, the complete medical records of a pool of patients from two major teaching hospitals of Lahore were reviewed. A total of 39 patients diagnosed to have typhoid Heal perforation at operation included 27 patients operated in the emergency of South Surgical Ward. Mayo Hospital Lahore from January 1998 to Dec 2000, and 12 consecutive patients operated by the surgical team of Surgical Unit 1L Shaikh Zayed Medical Complex. Lahore between December 2000 to May 2005. The average age was 26 years, the male-to-female ratio 4/1. The mean interval from admission to operation was 09 hours (range 05 hours – 03 days). Eight patients had more than one perforation at the time of operation. Primary repair of the perforation was performed in 22 % of the patients, ileostomy (prim ary repair and proximal loop ileostomy or exteriorization of perforation as a loop ileostomy) in 46%. and resection with end ileostomy and mucous fistula in 32%. No primary end-to-end anastamosis after resection was performed. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who underwent ileostomy. Three patients developed an enterocutaneous fistula requiring re-operation. The four deaths (10.25% mortality) resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No single operative procedure is best in all cases: therapy should be individualized and tailor made for every patient. Ileostomy appears to be an effective and safe procedure, particularly in patients with severe abdominal contamination and delayed presentation. Early diagnosis, aggressive resuscita tion with fluid and electrolyte optimization and prompt operation may result in improved survival in these seriously ill patients.

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