Typhoid Enteric Perforation Research Articles

Ileostomy in the Treatment of Typhoid Enteric Perforation Among Patients Presenting Late in The Hospital

Introduction: Typhoid enteric perforation is a communal acute emergency of abdomen in our hospital settings. Maximum patients in Pakistan come from rural zones and have a serious illness when presented in the laten final stages. Objective: To govern the importance of an ileostomy in cases of late presentation with enteric perforation. Study Design: A retrospective study. Place and Duration: In the surgical Department of Islam Medical College and Teaching Hospital Sialkot for one year duration from July 2020 to July 2021. Methods: 52 total patients of typhoid enteric perforation were included in our department. 5 to 32 years was the age range of patients with an average age of 16 years. Most of these patients have complaints of fever, abdominal pain, abdominal distension and vomiting Results: 52 patients with late presentation of typhoid perforation were alienated into 2 groups. All cases of group A underwent laparotomy and perforation exteriorization was done as loop ileostomy. In group A, when exteriorization was performed as the first procedure, fecal fistula was later developed in 12 cases. Ten of these cases had to be re-examined and the second perforation was found to be close to the original one. The mortality was observed in three cases. Conclusion: In a relatively normal-looking intestine, restoration of the margin, closure of the two layers of perforation, and ileostomy near the perforation are safer in the case of late onset of typhoid fever enteric perforation. Keywords: typhoid perforation, double-layer closure and ileostomy

Predictors of intestinal perforation in children with typhoid fever

Typhoid fever is a major public health problem globally; the greater burden however occurs in the developing countries because of lack of potable water and proper waste management. The disease is associated with a high mortality rate especially in those with enteric perforation or intestinal hemorrhage. The goal of this study was to identify the clinical and laboratory factors that predicts the development of enteric perforation in children with typhoid fever. This study was a retrospective case-control analysis of children admitted for typhoid fever with or without enteric perforation over a three – year period in a newly established teaching hospital in southwestern Nigeria. Forty-seven children with typhoid fever and enteric perforation (cases) were compared with 94 controls (those with typhoid fever but without enteric perforation). Multivariate analysis using logistic regression was applied to all the factors that were initially significantly associated with enteric perforation. Male sex (Odd Ratio, OR = 3.10, p = 0.003); inadequate treatment (OR = 3.03, p

Comparative Study of Free Omental Sheet Graft and Other Operative Procedures of Enteric Perforation Repair

Background/AimIn developing countries, enteric perforation due to typhoid continues to have very high morbidity and mortality rates irrespective of the type of operative procedure performed. The aim of the present study was to evaluate the effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison to other methods of enteric perforation repair in terms of decreased morbidity, mortality and cost-effectiveness. MethodA non-randomized study of 114 patients with enteric perforations was carried out over a period of 4.5 years. The study was divided in two groups; group I includes 38 cases in which a free omental sheet graft was used in typhoid enteritis with perforation and group II includes 76 cases in which other surgical procedures for enteric perforation repair were used. The outcomes were measured in relation to postoperative complications and mortality. ResultsThe incidence of complications including faecal fistula was 2.6 % in group I (free omental sheet graft group) versus 32.89 % in group II. The mortality rate of 2.6 % was also lower in group I versus 19.7 % in group II. ConclusionThis study concludes that the use of free omental sheet graft on typhoid enteric perforation site is effective in lowering the repair leak rate and thereby decreases the morbidity and mortality associated with these procedures. By lowering the complication rates, it also entails reduction in financial burden.

Single-layer closure of typhoid enteric perforation: Our experience

Typhoid enteritis is rare in developed countries. The increasing prevalence of typhoid fever with enteric perforation in our environment is alarming. Peritonitis follows enteric perforation due to typhoid enteritis. Surgical treatments and repair of the perforated areas due to typhoid enteritis varies between institutions with high mortality and morbidity. We retrospectively studied the effects of single versus double layer intestinal closure after typhoid enteric perforation with peritonitis in 902 pediatric patients from September 2007 to April 2012. All the patients underwent laparotomy after resuscitation and antibiotic cover. The patients were divided into two groups: group A (n = 454) double layer closure and group B (n = 448) single layer closure. There were 554 males and 348 females with male to female ratio 1.6:1. Ages of the patients were three years to 14 years with mean age at eight years and mode at nine years. The following clinical outcomes were recorded: burst abdomen 38 (8.3%) vs 3 (0.6%), enterocutaneous fistula formation 52 (11.4%) vs 8 (1.7%), superficial wound infection 215 (47.3%) vs 91 (20.3%), ligature fistula 13 (2.8%) vs 7 (1.5%), mean length of 29.4 ± 7.8 vs 45.3 ± 11.6. Our results showed that single layer closure of the perforated ileum due to typhoid enteric perforation with peritonitis in children was effective by reducing complication rates.

Risk factors affecting morbidity in typhoid enteric perforation

Typhoid enteric perforation is a cause of high morbidity and mortality. This study aim is to determine the factors affecting morbidity in patients with typhoid enteric perforation. Ninety-six patients with typhoid enteric perforation were reviewed. The variables are defined as follows: Age, gender, complaints, perforation-operation interval, typhoid fever treatment before the perforation or not, white blood cell (WBC) count, hemoglobin level (Hgb), intraoperative peritonitis intensity, the number of perforations, and type of surgery were examined. To determine the independent risk factors that might affect morbidity in typhoid enteric perforation, we made use of multivariate logistic regression analysis. Nine variables were applied the univariate analysis, which were greater than 30 years (P = 0.218), male gender (P = 0.02), preoperative treatment (P = 0.147), less than or equal to 48 h perforation-operation interval (P = 0.013), greater than 4,000 K/UL WBC (P = 0.388), less than 8 g/dL Hgb (P = 0.026), greater than 29 Mannheim Peritonitis Index (P < 0.0001), multiple perforation number (P = 0.614), and primary repair (P = 0.105). Logistic regression analysis showed that Mannheim Peritonitis Index (P = 0.014) and perforation-operation interval (P = 0.047) were defined as independent risk factors affecting morbidity. If liquid electrolyte, blood, antibiotics, and parenteral nutrition are applied in typhoid enteric perforation cases adequately, then severe peritonitis becomes an independent risk factor that affects morbidity. Early diagnosis and appropriate surgery type would decrease morbidity and mortality.

Typhoid intestinal perforation in children: a continuing scourge in a developing country

Typhoid intestinal perforation is a principal cause of morbidity and mortality affecting both adults and children. This study aims to evaluate the pattern of typhoid intestinal perforation and outcome of its management in Nigerian children. The records of consecutive children managed for typhoid intestinal perforation at Juth, between 1996 and 2005 have been reviewed. There were 184 children (M:F = 1.04:1), with a mean of 5.8 years (range 4 to 15 years). More than a half (62.5%) of the patients were in the 5-6 year age group. The incidence peaked in April-May, and November-December. Increased incidence of typhoid perforation was observed between 2002 and 2005. All patients presented with the classic features of typhoid enteric perforation. Hypokalaemia and anaemia were common at presentation. Only 75 (40.6%) patients had operation within 24 h of perforation. The types of surgery included simple excision of the edges of the peroration and closure (74.5%), wedge resection and closure in (14.5%), segmental resection with primary end-to-end anastomosis (3.6%) and right hemi-colectomy with ileo-colic or ileo-transverse anastomosis. Wound infection and dehiscence, anastomotic breakdown with faecal fistula, intra peritoneal abscesses and chest infections were the main post operative complications. The overall mortality rate was 22.8 (42). Excision and simple closure was associated with the least incidence of anastomotic breakdown and operation time. The incidence of typhoid intestinal perforation is on the increase at our institution. Early limited surgery provides optimal results.

Typhoid enteric perforation.

Of 306 cases of typhoid enteric perforation, 267 were reviewed retrospectively to determine prognostic indices and therapeutic options influencing outcome. The morbidity and mortality rates were 55.4 and 28.5 percent respectively, and the median duration of hospitalization was 18 days. On the basis of these findings, a prospective series of 39 patients was studied. In the preoperative period, aggressive resuscitation and antibiotic therapy with a combination of chloramphenicol, ampicillin/sulbactam and ornidazole were administered. All patients were given total parenteral nutrition to provide adequate metabolic support in the postoperative period. The morbidity and mortality rates decreased to 25 and 10 percent respectively, and the median hospitalization time was 12 days. The results of this study suggest that aggressive resuscitation and a combined antibiotic regimen in the preoperative period, selected operative procedure and metabolic support decrease the morbidity and mortality of typhoid enteric perforation.

Typhoid enteric perforation.

A review of 344 patients with typhoid perforation of the intestine is presented. Patients with enteric perforations should be treated with antibiotics, by fluid and electrolyte replacement and blood transfusion. Surgery is necessary to close the perforated gut and drain the contaminated peritoneum with the minimum surgical interference which will achieve these objectives. Although better conservative management has significantly reduced the mortality of typhoid perforation, early limited surgery is most important if good results are to be obtained.

Typhoid Enteric Perforation in Children in Calabar, Nigeria

Typhoid enteric perforation, a severely debilitating illness with a high mortality rate in children was studied in Calabar. The aim of the study was to determine the role that ingestion of herbal preparations, laxatives and enemas has on perforation and whether there is a relationship between the observed perforation and its occurrence within the first week of illness. Fifty-two patients with typhoid enteric perforations were selected from a pool of 178 cases of acute abdomen in children. Clinical, laboratory and radiological assessments were used to diagnose the condition and confirmation obtained intra-operatively. Results showed a male: female ratio of 3:1; with delayed presentation after 6 hours being a common feature in all patients with perforations. Sixty-three percent of the patients who were perforated had either consulted a traditional healer or chemist and had ingested a herbal concoction, a laxative or had an enema administered to them. Mortality was also higher within this group. Early resuscitation and surgical intervention within 24 hours of onset of illness led to a significant reduction in mortality. Seasonal variation was noted in the occurrence of typhoid fever. It was rampant during the dry season but rare during the rainy season. Key words: typhoid perforation, traditional healers, late presentation, seasonal variation Journal of Medical Laboratory Sciences Vol.12(1) 2003: 41-45

Risk factors for enteric perforation in patients with typhoid Fever.

A case-control study was performed using the records of patients hospitalized for typhoid fever at Dicle University Hospital, Diyarbakir, Turkey, between 1994 and 1998. Case patients with enteric perforation were compared with control patients with typhoid fever but no enteric perforation. Risk factors for perforation were determined using logistic regression modeling. Forty case patients who had surgery because of typhoid enteric perforation were compared with 80 control patients. In univariate analyses, male sex (p = 0.01), age (p = 0.01), leukopenia (p = 0.01), inadequate antimicrobial therapy prior to admission (p = 0.01), and short duration of symptoms (p = 0.01) were significantly associated with perforation. In multivariate analysis, male sex (odds ratio (OR) = 4.39, 95% confidence interval (CI): 1.37, 14.09; p = 0.01), leukopenia (OR = 3.88, 95% CI: 1.46, 10.33; p = 0.04), inadequate treatment prior to admission (OR = 4.58, 95% CI: 1.14, 18.35; p = 0.03), and short duration of symptoms (OR = 1.22, 95% CI: 1.10, 1.35; p = 0.001) were significant predictors of perforation. A short duration of symptoms, inadequate antimicrobial therapy, male sex, and leukopenia are independent risk factors for enteric perforation in patients with typhoid fever.

Risk factors of typhoid enteric perforation in Guatemalan people

Risk factors of typhoid enteric perforation in Guatemalan people

Typhoid Enteric Perforation

Typhoid Enteric Perforation

Typhoid enteric perforation.

Perforation of the bowel is the most serious complication of typhoid fever. The role of early limited surgery in managing these patients needs to be assessed. The records of 110 cases of typhoid enteric perforation treated at JLN Hospital, Ajmer between 1990 and 1995 were reviewed. A total of 42.7% of the patients were in the 21-30-year age group, and 83.6% were male. All patients presented with the classic features of typhoid enteric perforation. A total of 83.6% were operated on within 36 h of perforation. Surgical management consisted of primary closure of the perforation (74.5%), closure with omental graft (14.5%), resection and anastomosis (3.6%), and only drainage (7.3%). A total of 79.1% of patients developed wound infection and 10% of patients developed faecal fistula. The overall mortality rate was 16.4%. Increasing the time interval between perforation and operation significantly increased the mortality (P < 0.05). The mortality was least with early primary closure of the perforation. Patients with postoperative faecal fistula had higher mortality rates (P < 0.001). Early limited surgery with thorough peritoneal lavage provides optimal results, faecal fistula is a grave complication, and the use of the McBurney incision may provide better results in terms of subsequent wound healing.

Typhoid enteric perforations.

Forty-five cases of typhoid enteric perforation are presented. The disease was most common in young males. Half of the perforations occurred during the second week of fever. Diagnosis was mainly clinical, supplemented by radiological evidence of pneumoperitoneum and confirmed at laparotomy by the presence of perforations in the terminal ileum. Laboratory investigations including Widal perforations in the terminal ileum. Laboratory investigations including Widal test and blood culture were of little value. All the 45 were managed operatively by simple closure of the perforation(s) and drainage of the peritoneal cavity. Burst abdomen occurred in 9 per cent and fecal fistula in 20 per cent. Overall mortality was 11 per cent--much lower than that reported in the literature in case of management of typhoid enteric perforations.