Typhoid Ileal Perforation Research Articles

Postoperative Outcomes And Surgical Complications In Typhoid Ileal Perforation

Surgical repair for typhoid ileal perforation is essential to prevent peritonitis and sepsis. Postoperative outcomes, which include survival rates and recovery times, underscore the importance of comprehending surgical complications to refine treatment strategies and enhance patient survival. Objective: To determine postoperative outcomes and surgical complications in typhoid ileal perforation. Methods: The prospective cohort was conducted at General Surgery Department of Liaquat University Hospital in Hyderabad & Jamshoro. 228 Patients of age 18 years or more and of any gender, who were operated for having single typhoid ileal perforation, were included in the study. While patients with multiple perforations, TB peritonitis or having traumatic perforations, were excluded from the study. Results: The most common age group was found to be 18-30 years (40.4%), followed by 31-40 years (28.1%), 41-50 years (19.3%), 51-60 years (7.9%), and >60 years (4.4%). Males comprised 57.9% of the population, while females made up 42.1%. The mean length of hospitalization was found to be 14 ± 5 days. The majority of patients experienced good outcomes, accounting for 158 individuals (69.3%), while 70 patients (30.7%) had adverse outcomes. Among the adverse outcomes, there was a mortality rate of 7.2% (16 patients) and 54 patients (23.7%) experienced complications, some experienced more than one complication. Conclusions: The study concluded that though the majority of patients recover well, a significant proportion (7.2%) still faced adverse postoperative outcomes in terms of mortality. 54 patients (23.7%) experienced complications, some experienced more than one complication.

Defunctioning ileostomy for typhoid ileal perforations: Out of the frying pan into the fire?

Typhoid ileal perforation (TIP) is a common surgical emergency in low-middle income countries (LMICs). Its high surgical morbidity and mortality is due to its often late presentation or diagnosis, the patient's malnutrition, severe peritoneal contamination and unavailability of intensive care in most peripheral hospitals. This prompted the philosophy of minimizing the crisis by avoiding any repair or anastomosis, limiting the surgery in these physiologically compromised patients and performing only a temporary defunctioning ileostomy (DI) which could then be closed 10-12 weeks later.

EVALUATION, MANAGEMENT AND OUTCOME OF GASTROINTESTINALPERFORATIONS

Background: GIT perforation in an emergency is the third most frequent reason for explorative laparotomy.The occurrence of perforated peptic ulcers has decreased with thedevelopment of proton pump inhibitors. The methods for identifying and treating stomach and colon-rectal perforations have significantly changed with the development of laparoscopy and endoscopy Methods: All patients admitted and treated with perforation secondary to Hollow viscous perforation in surgical wards admitted during the period of JAN 2020 to JULY 2022 at Maharaja s institute of medical sciences, Vizianagaram Patients with Hollow viscus perforation admitted will be evaluated and the diagnosis will be made with history, clinical features and X-Ray Abdomen erect posture to support the diagnosis. Each case will be studied as per the proforma developed specifically for this study. Follow-up assessments will be done at first and third month during the postoperative period. Results: All the 30 cases weremanaged surgically with emergency laparotomy under General Anaesthesia.Out of 30 cases, 13 were appendicular perforations, 14 were acid pepticperforations in gastroduodenal region with single case of malignant gastricperforation, 1 idiopathic colonic perforation and 1 typhoid ileal perforation werenoted. Conclusion: Most common age of presentation is 3rd and 5th decade with male preponderance.Gastroduodenal perforation was the commonest cause of gastrointestinalPerforation followed by appendicular perforation. Peptic ulcer disease is most common etiology of GI perforation followed by appendicularperforation.

Typhoid Ileal Perforation: Comparative Study of Ileostomy Versus Primary Repair and associated Morbidity and Mortality

Objectives: To study the result of primary repair with ileostomy in cases of typhoid ileal perforation.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Surgery, Jinnah Postgraduate Medical Center, Karachi Pakistan, from May 2019 to Jun 2020
 Methodology: Participants who were operated on for typhoid ileal perforation were included, while patients who presented with a hollow viscus perforation other than ileal perforation were excluded from the study. Peritoneal lavage and exploration were performed. All per-operative findings were documented. In addition, the socio-demographic and clinical parameters, including the postoperative complications and morbidity/mortality, were documented.
 Results: Out of the 73 individuals with ileal perforation included in this research, 52 underwent primary repair, whereas 21 underwent ileostomy. Patients who had undergone ileostomy had a higher morbidity (61.90%) and mortality (19.00%) rate than patients in the Primary Repair Group. In addition, patients in the ileostomy Group had significantly higher rates of wound dehiscence and infection, electrolyte imbalance, and weight loss than patients in the Primary Repair Group.
 Conclusion: The current study indicates that primary repair is an ideal procedure for typhoid ileal perforation compared to an ileostomy.

Comparison of Outcomes of Primary Repair Versus Ileostomy in Typhoid Ileal Perforation in Different Age Groups

Background: Procedure of ileostomy in patients of Typhoid fever perforation with friable gut defunctions the diseased gut, repair the infected fecal matter, protects the intestinal repair done in septic tissues and reduces the anastomotic dehiscence. Method: This was a Randomized controlled study. Started in November 2015 to May 2016 at BMC Hospital balochistan. Main objectives were to compare the infectionof postoperative wound between ileostomy and primary closure in patients undergoing surgery for Typhoid fever ileal perforation. Study done by One fifty patients who underwent Typhoid fever perforation surgery. The surgical management was done as primary repair (group-A) and ileostomy (group-B). Postoperative complications were evaluated till 5 days of hospital stay. Comparison between two groups was done using chi square. Stratification was done and p-value ≤0.05 was considered as significant. Results: In group-A 47 male and 28 females and in group-B 52 male and 23 female patients were included. In group-A, 40 Percent observed wound discharge while in group-B it was 24 Percent. In group-A, acceptable comesis were observed for 80 Percent patients and in group-B, it was 93.3 Percent. Results showed significant association of wound discharge and acceptable cosmesis with the two study groups. Conclusion: Better outcome in ileostomy group than primary repair group was significant observed in the study. Keywords: Typhoid fever , Salmonella Typhi Acceptable cosmesis, Wound Discharge, Intra Abdominal Collection, Ileostomy, Typhoid fever Ileal Perforation

Policies for Improving Access to and Quality of Basic and Essential Surgical Care at District Hospitals in Ghana

Background: Ghana Health Service has, as one of its major functions, the provision of accessible healthcare to the rural population with regards to surgical and other medical problems requiring hospital care.
 Methods: Data was obtained from ten district hospitals through interviews with health personnel, from theatre records and by the completion of a questionnaire before the visit of research team members, who then interviewed the person who completed the questionnaire.
 Results: None of the physicians working in these facilities had any formal surgical training beyond that obtained in medical school and during a six-month rotation each in surgery and obstetrics and gynaecology. They performed various emergency and elective surgical procedures such as caesarean sections, laparotomies for typhoid ileal perforation, herniorrhaphies, excision of lumps, among others.
 Outcome measures: Interim measures to expand the quantity and quality of emergency and ssential surgical care at district hospitals include compulsory short-term surgical training for medical officers prior to assuming their responsibilities, making available opportunities for continuing short-term surgical education and additional surgical training for medical officers currently working in district hospitals, provision of financial and nonfinancial incentives to physicians with surgical training or surgical experience to entice them to occupy positions in such facilities and training of diplomates and non-physician clinicians to perform the most common emergency and essential surgical procedures.
 Conclusion: In the absence of surgical specialists in the District Hospitals, measures are needed to expand access to proper emergency and essential surgical service for the over 60% of the rural population.

Outcome of Acute Peritonitis Related To Cause and Duration Of Presentation

Objective: To determine the outcome of acute cause-related peritonitis correlated with the duration of inflammation within 24, 24-48, and after 48 hours of hospital admission. Methodology: This quasi experimental study was conducted at Surgical Ward #3, Jinnah Postgraduate Medical Centre from September 2019 to March 2021. Patients over 12 years old were included in this study. The duration, cause, and outcomes of peritonitis were noted. All complications were recorded and treated accordingly. Results: 136 patients between the ages of 13 to 80 years old were included, 104 were males (76.8%) and 32 females (23.18%). 37 patients (28.2%) were aged 13–20 years, 61 (44.2%) were aged 21–40, 33 (23.91%) were aged 41–60, and 5 (3.6%) were aged over 60 years. Mortality showed 2 patients (1.47%) expired in 24–48 hours, and 6 (4.4%) in 48 hours.  The cause of peritonitis included typhoid ileal perforation (41%), duodenal perforation (33%), ruptured appendix (28%), intestinal tuberculous (14%), gangrenous gut (7%), tumour perforation (6%), liver abscess (3%), and gastric perforation and rectal tear (1%). Notably, 2.4% of patients with typhoid peritonitis, 3.0% with duodenal perforation, 3.5% with ruptured appendix, 14.2% with tuberculous intestine, 33.3% with tumour perforation, and 100% with liver abscess perforation passed. Paralytic ileus (8%) and burst abdomen (8%), were the most common complications. Conclusion: Typhoid ileal perforation was the major cause of peritonitis, and paralytic ileus and burst abdomen were the most common complications contributing to the mortality rate.

Diabetic Ketoacidosis Misdiagnosed and Managed as Typhoid Ileal Perforation in a Ghanaian Child: A Case Report

We report on a 15-year-old Ghanaian boy, who presented to a district hospital with diabetic ketoacidosis (DKA) but was diagnosed wrongly as a small bowel perforation due to typhoid fever. He presented with weakness, poor feeding, vomiting, and severe abdominal pain. General examination revealed a lethargic, drowsy, and severely dehydrated patient. His abdomen was diffusely tender more in the right ileac fossa. Investigations including complete blood count, blood smear for malaria parasites, urinalysis, and abdominal ultrasound yielded unremarkable results. Hemoglobin level was 12.4 grams per decilitre. He was diagnosed as typhoid ileal perforation and laparotomy was done, but the bowels and all other intra-abdominal organs were found to be normal. A blood glucose test was done intraoperatively, and it found very high hyperglycaemia. This led to the suspicion of DKA, which was confirmed through urine dipstick testing for high urine ketones and a high glycated hemoglobin (HbA1C) test result. He was then treated for DKA, which resolved on the second day of admission, but the surgical wound healed after twelve days.Our account emphasizes the need for testing for blood glucose in critically ill children and adolescents with suspected severe infections or acute medical conditions that require admission or surgical intervention. This owes to the fact that the clinical features of undiagnosed diabetes, especially if it progresses to DKA, are similar to those of infections and disorders managed via surgical treatment, which are rather more common in Ghana and Africa.

Postoperative Enterocutaneous Fistula: A Severe and Desperate Complication in a Disadvantaged Surgical Setting

Purpose: Digestive or gastrointestinal fistula is one of the most feared postoperative complication along with dehiscence and infection. The aim of this study was to determine the etiological, clinical and therapeutic aspects of enterocutaneous fistulas in a disadvantaged surgical setting. Methods: This was a retrospective study covering a period of three years (January 2018 to December 2020) including records of patients managed for postoperative enterocutaneous fistula in the general surgery department of the Ignace DEEN national hospital in Conakry (Guinea). Results: During the three years of study, we compiled 69 records of patients with postoperative enterocutaneous fistulas, representing 14.68% of all postoperative abdominal complications registered in the department (n=468). The mean age of the patients was 29.61±17.32 years. In this series, 53 patients (76.81%) were initially operated in private health facilities and then referred to our department after the occurrence of the fistula. The most frequent indications for initial surgery were typhoid ileal perforation (37.68%) followed by appendicitis (26.09%) and sigmoid colon volvulus (15.94%). Spontaneous closure of the fistula was obtained in 41 patients (59.42%) with a mean time of 23 days. We noted 18 deaths (26.09%). Conclusion: Postoperative enterocutaneous fistula is a severe complication whose management in our environment is difficult and desperate for both patient and surgeon.

Spectrum of Paediatric Surgical Cases in a Private Mission Teaching Hospital in Nigeria

Introduction:Establishing the nature of conditions requiring surgery among children in a particular location may be crucial for policy formulation and implementation as regards paediatric surgery.Objective:This study aimed to describe the pattern and outcome of paediatric surgical cases operated upon in a newly established paediatric surgical unit in Nigeria.Subjects and Methods:This was a cross-sectional study of all subjects that were operated upon by the paediatric surgery unit over a 28-month period. Data obtained included age, sex, diagnosis, timing of surgery, post-treatment complications and outcome. Diagnoses were categorised based on the International Classification of Diseases 11th revision for morbidity and mortality statistics. Data analysis was done using Stata version 12.Results:A total of 377 procedures were performed on 336 patients with a male-to-female ratio of 2.1:1. The median age at surgery was 36 months. Disorders of the digestive system (184, 48.8%) and developmental anomalies (119, 31.6%) accounted for majority of the cases, with inguinal hernias and hydrocoeles accounting for 17.0% of all cases. Thirty-six per cent of the procedures were emergent ones, and the overall complication rate was 23.6% (89/377). The unplanned re-operation rate was 7.4% (25/336) and mortality rate was 5.1% (17/336). Typhoid ileal perforation was responsible for 4 (23.5%) of the deaths.Conclusion:Congenital anomalies and surgical infections represent a major surgical burden among children in our sub-region of Nigeria. There is, therefore, the need for focused research on these conditions and the integration of children surgery into public health programmes for children in sub-Saharan Africa.

Spectrum of presentation and prognostic factors in non-traumatic small bowel perforations

Background: The small bowel perforation peritonitis is one of the main causes of generalized acute peritonitis in developing countries.The aim is to find out the prognostic factors affecting the mortality and morbidity of non-traumatic small bowel perforations.Methods: A total of 50 patients of any age and either gender of non-traumatic small bowel perforation peritonitis were included and studied prospectively. The prognostic evaluation was assessed by the impact of pre-operative prognostic factors and per operative findings on post-operative complications and mortality.Results: One third of the patients were of 20-30 years of age followed by 18% who belonged to 10-20 years age group. Operative findings revealed mean duration of surgery was 2 hours. Majority of patients (33) had bilio-purulent peritonitis. Post-operative pulmonary complication revealed 56% (28 out of 50) patients were having pulmonary complications. Post-operative wound complication showed surgical site infection as the most common complication noted and managed by sending wound culture and changing antibiotics. Second most common was burst abdomen managed initially by dressing and thereafter secondary wound closure. Delay in intervention (DII) had significant correlation with world society of emergency surgery (WSES) score and amount of peritoneal fluid.Conclusions: Most common cause of non-traumatic small bowel perforation was typhoid ileal perforation with most common presentation being pain abdomen. The significant factors defining the outcome of these patients were volume of intra-peritoneal fluid (purulent/fecal) >1000 ml, WSES score >6 and Mannheim’s peritonitis index (MPI)>18.

Feasibility and efficacy of ghost ileostomy in typhoid ileal perforations: A prospective observational study.

Loop ileostomy is commonly performed for typhoid ileal perforations as temporary faecal diversion. This is associated with several stoma-related complications and also requires further surgery for its closure. Thus, we were prompted to conduct a prospective observational study on the safety, feasibility and efficacy of ghost ileostomy in typhoid ileal perforations. After dealing with the perforation, a ghost ileostomy was performed in 10 selected patients with favourable circumstances; otherwise, a conventional loop ileostomy was performed in 19 patients. The two groups were comparable (p > 0.05) for morbidity and mortality except for stoma-related complications, seen only in the loop ileostomy group. Body weight was better preserved in the ghost ileostomy group. One patient in the ghost ileostomy group required conversion to loop ileostomy owing to signs of intra-peritoneal suture leak, without any detriment to outcome. Our study shows safety, feasibility and efficacy of ghost ileostomy in selected patients with typhoid ileal perforations, thus avoiding loop ileostomy in one-third of patients.

Causes of Acute Peritonitis and Its Complication.

IntroductionPeritonitis is a significant cause of morbidity and mortality in surgical settings. Coexisting premorbid illness and postoperative complications were found to be associated with death. This study aimed to analyze various etiologies that cause peritonitis and shed light on the factors responsible for unsatisfactory results.MethodThis longitudinal study included 309 patients above 12 years of age, of either gender, with confirmed diagnosis of peritonitis. Exploratory laparotomy was done to identify the cause of peritonitis. Patients were monitored postoperatively till their discharge or death for the development of complications.ResultsOur results showed that the most common cause of acute peritonitis was duodenal perforation (26.2%), followed by typhoid ileal perforation (24.2%) and ruptured appendix (16.8%). At least one complication was observed in 31% of the participants. The most common complication was dehydration (18.8%), followed by septicemia (11.3%) and paralytic ileus (6.4%). Ten (3.2%) patients died in the hospital.ConclusionsAcute peritonitis is a serious surgical emergency caused by a number of diseases. Early surgical treatment along with antibiotics, followed by aggressive resuscitation can yield improved outcomes in patients with peritonitis.

TyphicIleal Perforation at Kati Chu-BSS for Diagnostic and Therapeutic Aspects (Mali)

Ileal perforation of typhus origin is a common and serious complication of typhoid fever in tropical environments. It is one of the main causes of morbidity in surgery in Mali. However, it would be preventable if salmonellosis were properly managed upstream, and if our living environments were cleaned up. The purpose of this study is to report on the experience of the Kati UHC General Surgery Department in the management of peritonitis by typhic perforation and to assess its prognosis. Patients and Method: This is a retrospective descriptive study that took place from January 2007 to December 2020 in the General Surgery department of the Hospitalo-University BSS Center of Kati (Mali). We have included patients who have undergone peritonitis with confirmed typhic ileal perforation with laparotomy. The other etiologies of peritonitis by ileal perforation were not retained. Results: In 14 years, we collected 89 cases of peritonitis by typhic ileal perforation. It accounted for 3.14% (89/2829) of surgical procedures, 37.5% (89/1181) of visceral surgical emergencies and 27.6% (89/322) of all acute peritonitis causes combined. There were 70 men against 29 women; the sex ratio was 2.4 with an average age of 25.8 years (extremes 8 years to 65 years). Anastomosis resetions (ileo ileal and ileocolic) predominated in 71.8% of patients. However, the ileo stoma was performed in 5.6%. A significant relationship (p 0.05) was observed between high mortality and MPI score > 26. Morbidity was 39.4% with mortality of 15.7%. The average length of stay in hospital was 12.2 days. Conclusion: Typhoid ileal perforation is common in young male adolescents in visceral surgery. This pathology generates significant morbidity. However with the extension of hand washing after Ebola disease its frequency has dropped.

Frequency and Complications of Ileostomy.

IntroductionIleostomies are life-saving procedures used for temporary fecal diversion in complicated cases of ileal perforation. However, an ileostomy is associated with several complications. The goal of this study was to determine the frequency and complications of ileostomy in the Jinnah Postgraduate Medical Centre, Karachi, Pakistan.MethodologyWe conducted a longitudinal observational study from July 2019 to July 2020. All patients older than age 12 receiving an ileostomy were included. Patient examinations were conducted on the first postoperative day and were assessed for hemorrhage and necrosis. Examinations were conducted on the seventh postoperative day to assess stoma retraction, stenosis, prolapse, and high-output fistula. Patients were monitored via follow-up in the outpatient clinic every 15 days to record any complications for three months until the reversal was performed. All data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. (Armonk, NY: IBM Corp.).ResultA total of 84 patients who received ileostomies were included in the study. Most patients were male (n=62; 73.8%), and 22 were female (26.19%). Of the 84 patients in our study, 34 (40.48%) had tuberculous intestine, 23 (27.38%) had typhoid ileal perforation, 23 (27.38%) were trauma patients, and four patients (4.7%) had gangrenous appendicular perforation. 23 patients (27.3%) were discharged with no complications, and 61 patients (72.69%) developed complications. The most common complication was skin excoriation (19.4%), followed by wound infection (13%), nonfunctioning stoma (11.9%), prolapse and stenosis (6%), retraction (4.7%), high-output fistula (3.5%), parastomal hernia and necrosis (2.3% each), and hemorrhage (1.1%).ConclusionIleostomy is a common and lifesaving surgical diverting procedure. It is still common in our clinic due to late presentation by patients who need the procedure. Complications are common but manageable. Therefore, it is essential to recognize these complications and manage them early to reduce the morbidity of the patients.

GUM chewing decreases the duration of postoperative ileus after ileostomy reversal: A single center experience.

Post-operative ileus is a common compliant of patients at surgical floor. Studies have reported that gums chewing after abdominal surgeries decrease postoperative ileus (POI); but very few studies are available on role of chewing gum in ileostomy reversal cases. We concluded that post-operative gum chewing with standard post-operative care in patients undergoing elective surgery for ileostomy closure done for typhoid ileal perforation in terms of mean length of hospital stay and mean time of passage of first flatus is significantly better than those without gum chewing. Objectives: To compare post-operative gum chewing with standard care in cases having elective ileostomy closure in terms of mean length of hospital stay and mean time of passage of first flatus. Study Design: Randomized Control Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: 1st January 2017 to 31st December 2017. Material & Methods: Patients of 20 to 60 years undergoing elective surgery for typhoid ileal perforation were included in the study after informed consent. Two groups with A: allocated to chewing gum three times a day up to discharge; Control group: allocated to standard post-operative care without chew gum. Length of hospital stay and time of passage of first flatus was noted. Results: In this study, mean length of hospital stay in Chewing gum group was 7.73+0.74 days and 10.27+0.87 days in Control group, p value was 0.0001, mean time of passage of first flatus in Chewing gum group was 49.97+1.69 hrs and 89.17+2.07 hrs in Control group, p value was 0.0001. Conclusion: We concluded that post-operative gum chewing with standard post-operative care in patients undergoing elective surgery for ileostomy closure done for typhoid ileal perforation in terms of mean length of hospital stay and mean time of passage of first flatus is significantly better than those without gum chewing.

Our Experience with Typhoid Ileal Perforation at Tertiary Care Centre Over a Period of 2 Years

Our Experience with Typhoid Ileal Perforation at Tertiary Care Centre Over a Period of 2 Years

Outcome of primary repair in typhoid ileal perforation at Tertiary Care Hospital.

Typhoid ileal perforation is the common complication of typhoid fever in third week of its phase of progression. It is the most common cause of mortality in developing countries. Small perforations are dealt with primary repair and the more complicated disease is treated by multiple other options. Prognosis is good with primary repair with least postoperative complications. Objectives: To detect the outcome of typhoid ileal perforation treated by primary repair at tertiary care hospital. Study Design: Cross sectional study. Setting: Surgical Department of PMC Hospital Nawabshah. Period: From August 2017 to December 2018. Material & Methods: This study included total 70 patients. All patients were admitted from surgical OPD and emergency department of PMCH Nawabshah. Out of 70, 45 (64.28%) were females and 25 (35.71%) were male patients. Age ranged from 27 to 52 and 24 to 47 in females and males respectively. The common presentation was pain in whole abdomen along with distention and fever, vomiting. Plain X ray chest/ Abdomen and ultra sonography showed gas under diaphragm. Primary repair was done and also other surgical options but our study included only the postoperative outcomes of primary repair of typhoid ileal perforation. A few complications were detected after primary repair of the gut perforation. Results: Total 70 patients were included in this study. 45 (64.28%) were females and 25 (35.71%) were male patients. In females, 25 (55%) were found single perforations of less than 1cm whereas 7 (15.5%) had size of perforation less than 1.5 cm. In 25 males, 11 (44%) had single perforations of less than 1cm in size. 2 (8%) had < 1.5 cm size perforations and 12 (48%). Over all complication rate in this study was 26%. Conclusion: Primary repair is the best surgical option to treat typhoid ileal perforation in selected patients with least postoperative complications.

A study of 40 cases typhoid ileal perforation

Review the patient of ileal typhoid perforation treated in surgical department in S.S.G. hospital Baroda. In present study, age and sex distribution, 31 male (77.5%) and 9 females (22.5%), clinical presentation role of investigation. To assess the morbid pathology and evaluate the complication arising from ileal perforation due to late presentation, multiple perforation and the incidence of faecal fistula and the mortality rate adversely affected by drainage of copious quantities of pus and faecal material from the peritoneal cavity. The complication arising from ileal typhoid perforation and those following surgery for the same and role of various operative procedure in the management of patient with ileal typhoid perforation.to study the incidence of mortality and morbidity in patient with typhoid perforation.

Surgical Management of Typhoid Ileum Perforations: A Systematic Review

Background: Typhoid is a disease caused by a gram negative bacterium Salmonella typhi. Prolonged infection leads to necrosis in the Peyer's patches of the antimesenteric border of bowel leading to intestinal perforation. Various surgical procedures have been described for the treatment of these perforations. Typhoid intestinal perforations are still associated with high case fatality rates averaging 15.4%.
 Objective: To identify current surgical management options for typhoid ileal perforations and to describe the best surgical management in relation to mortality and complications.
 Methods: A systematic review was done using PRISMA guidelines. Common search terms used were typhoid perforation/typhoid ileal perforation management. A narrative synthesis of the findings from the included studies structured around the type of intervention, target population characteristics, types of outcome and intervention content was done.
 Results: Primary closure of ileal perforations was the most commonly performed procedure.Ileostomy is the choice of surgery for severe abdominal contamination and when the patient has poor general health. Most studies found mortalities and complications to be unrelated to surgical procedure done. Mortality was significantlyassociated with the number of perforations and abdominal contamination.
 Conclusions: Individual studies support particular surgical interventions but the review showed that complications and mortality are not related to the type of surgical intervention alone but to a number of other non-surgical factors. There is need for further level 1 studies on this topic.