Muhammad Tayyab, Mahmud Aurangzeb, Tariq Saeed Akhunzada, Ift Ikhar Muhammad Khan.
Perforation-operation interval as a prognostic factor in Typhoid ileal perforation.
Pak J Surg Jan ;26(1):24-7.

Objective: To fi nd out signifi cance of perforation-operation interval in relation to early prognosis in patients with peritonitis due to Typhoid ileal perforation. Study design: Prospective study. Place and duration: Th e study was conducted in the Surgical Department of Khyber Teaching Hospital Peshawar from 25th February 2005 to 30th January 2006. Patients and methods: Th e study included 50 patients with typical history of typhoid fever presenting with generalized peritonitis diagnosed as typhoid ileal perforation on clinical and radiological grounds. All patients with generalized peritonitis due to non typhoid ileal perforation like trauma, tuberculosis, ulceration and malignancy were excluded from the study. Data was collected in the proforma designed for the study. Results: Th ere were 35 males and 15 females with mean age of 33.5 years. Fever, abdominal pain, vomiting and constipation were common symptoms while abdominal distention, abdominal tenderness, guarding, silent abdomen on auscultation and pulse rate >90/mimute were the common signs. Depending upon the time between perforation/ peritonitis and operation we divided the patients into 3 groups i.e. Early, Late and Very late. Mean duration of perforation-operation interval was 34.8 hours. A total of 8 (16%) patients developed complications and wound sepsis was the most common which occurred in 4 (8%) patients. Only one (2%) patient from Early group developed wound sepsis. Post operative hospital stay ranged from 7 to 11 days with a mean of 9.2 days (standard deviation: 1.03). No mortality was seen in our study. Conclusion: Typhoid ileal perforation is associated with decreased morbidity and mortality if recognized and presented early followed by aggressive resuscitation and early surgery in expert hands.

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