Jahangir Sarwar Khan, Hamid Hassan, Faisal G Bhopal, Nadir Mehmood, Naeem Taj, Junaid Alam Khan, Mohammad Iqbal.
Typhoid Perforation: A ten year experience in a Surgical Unit.
J Rawal Med Coll Jan ;6(2):70-3.

Background: To determine the incidence and evaluate the management of typhoid perforation. Methods: In this retrospective study conducted at Surgical Unit-I, Rawalpindi General Hospital from January 1989 to December 1998, a total of 121 patients presented with typhoid perforation. Simple closure of perforation was done in 101 cases who presented early and were haemodynamically stable. In the haemodynamically unstable patients, ileostomy was performed. Results: The male to female ratio was 4.51. Commonest age group affected was 21 to 30 years. Maximum number of patients presented in September. Most common clinical features included fever, abdominal pain, tenderness and guarding. 101 (83.5%) patients presented within 48 hrs of onset of symptoms which was responsible for the low mortality rate in our study. Combination of pneumoperitoneum and a positive Widal test were the most important investigations for diagnosis of typhoid perforation. Solitary perforation was found in 102 (85%) patients. Incidence of serious complications like fecal fistula and burst abdomen was 5% each. Overall mortality was 8.2%. Conclusions: The incidence of typhoid perforation is decreasing, mainly due to effective treatment. Early presentation and proper management decreases morbidity and mortality associated with this complication.

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