Typhoid Perforation Research Articles

A clinical comparative retrospective cohort study in the surgical management of enteric perforation, by comparing primary closure and closure with free omental sheet graft

Background: Typhoid ileal perforations have high morbidity and mortality rates irrespective of the type of surgeries performed. The aim of this study is to evaluate the morbidity, mortality and cost-effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison with a primary ileal perforation closure.Methods: This study includes a total of 81 patients with enteric perforations in a span of 5 years from March 2009 to February 2014. The study was divided into two groups; group 1 included 40 cases in which primary enteric perforation closure was done and group 2 included 41 cases in which a free omental sheet graft was used in typhoid enteritis with perforation. The outcomes were measured in relation to various postoperative complications and mortality.Results: 90% of the patients in Group 1 had surgical site infection and 65% of the patients in Group 2 had surgical site infection. Intra-abdominal abscess was seen in 5% of the patients in Group 1, whereas no such morbidity was found in Group 2. 25% of the Group 1 patients had fecal fistula compared to none in Group 2. The mortality rate in Group 1 was 10% and no mortalities were seen in Group 2.Conclusions: Primary closure with free omental sheet graft has shown better results, compared to primary closure alone, in terms of morbidity, mortality and length of hospital stay, irrespective of the site of perforation.

Determinants of postoperative morbidity and mortality in children managed for typhoid intestinal perforation in Kano Nigeria.

Intestinal perforation is a serious but poorly understood complication of typhoid fever. This study aims to determine the patient factors associated with postoperative morbidity and mortality. We retrospectively reviewed the records of all children presenting to our unit with typhoid intestinal perforation (TIP) between March 2009 and December 2013. The patients were grouped based on postoperative outcome status and were compared with respect to patient related variables, using chi square test. Multivariate analysis was performed using a binary logistic regression model. Significance was assigned to a p-value <0.05. The records of 129 children were analyzed. There were 78 (60.5%) boys and 51 (39.5%) girls. The male/female ratio was 1.53:1. Their ages ranged from 3years to 13years (mean 8.14years; SD 2.61years). A single intestinal perforation was seen in 73.4% (94/128) of them, while 26.6% (34/128) had two or more. Mortality rate was 10.9%. Multivariate analysis showed that multiple intestinal perforations significantly predicted postoperative mortality (p=0.005) and development of postoperative fecal fistula (p=0.013), while serum albumin <32g/L was a predictor of postoperative surgical site infection (p=0.002). Multiple intestinal perforations, a postoperative fecal fistula and hypoalbuminemia adversely affected outcome in our patients. III (Retrospective study). Type of study-Prognosis study.

Results after surgical management of ileal perforation due to typhoid fever, about 29 cases in Ouahigouya (Burkina Faso)

The aim of this study was to determine the results of management of typhoid perforations. This was a descriptive cross-sectional study carried out from January 1, 2016 to December 31, 2016 in the General Surgery Department of the Regional Teaching Hospital Center of Ouahigouya (Burkina Faso). It involved 29 operated patients, in whom the diagnosis of typhoid perforation was confirmed at laparotomy: age, sex, admission time, clinical, therapeutic and prognostic aspects were analyzed. Typhoid perforations accounted for 20% of acute generalized peritonitis and 38.1% of digestive perforations. Twenty-three patients were males and six were females (sex-ratio: 3.8). The average age of patients was 19 years. The mean diagnostic time was 9.8 days. The excision-suture of the perforation was the most used technique with 62% of the cases. The treatment lead to complications in 10 cases with a morbidity of 34.5%. Four deaths were recorded, representing an overall mortality of 13.8%. Prognostic factors were diagnostic delay, age, number of perforations and resection-anastomosis.

Typhoid perforation in children: an unrelenting plague in developing countries.

Despite global scientific development, typhoid fever and subsequent typhoid perforation have continued to be common in developing countries. The aim of this study was to re-evaluate the pattern of presentation and management outcomes as well as morbidity and mortality of typhoid perforation among children. Children aged 15 years and under with clinical diagnosis of typhoid perforation were retrospectively studied by reviewing their hospital records between January 2006 and December 2015. Demographic and clinical data were analyzed with SPSS using descriptive statistics and the chi-squared test or Cramer's V for continuous and categorical variables respectively. 105 children had typhoid fever, 56 (53.3%) of them were diagnosed with typhoid perforation and 49 were confirmed intra-operatively. Of the children, 55.1% (n = 27) were school-aged while the remaining were adolescents; a majority had the classical triad of persistent fever (100%), abdominal pain (100%) and abdominal swelling (93.9%). Anaemia and hypokalaemia were common. The mean time duration for resuscitation was 16 hours (range 6-36 hours). Most perforations were single (n=36, 73.5%). There were more perforations in the school-aged than adolescent children (p = 0.845; V = 0.298). Wound infection (34.7%) was the most frequent morbidity but faecal fistula (10.2%) was most troublesome to manage. Death followed severe sepsis and chest infections in four children (8.2%). Typhoid perforation continues to cause morbidity and mortality in children in developing countries. To stem this endemic disease, community health education and improved living conditions are required.

Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015

BackgroundBetween January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investigation to characterize TIP cases and identify modifiable risk factors for TIP.MethodsWe defined a TIP case as a physician-diagnosed typhoid patient with non-traumatic terminal ileum perforation. We identified cases by reviewing medical records at all five major hospitals in Kampala from 2013 to 2015. In a matched case-control study, we compared potential risk factors among TIP cases and controls; controls were typhoid patients diagnosed by TUBEX TF, culture, or physician but without TIP, identified from the outbreak line-list and matched to cases by age, sex and residence. Cases and controls were interviewed using a standard questionnaire from 1st -23rd December 2015. We used conditional logistic regression to assess risk factors for TIP and control for confounding.ResultsOf the 88 TIP cases identified during 2013–2015, 77% (68/88) occurred between January and June, 2015; TIPs sharply increased in January and peaked in March, coincident with the typhoid outbreak. The estimated risk of TIP was 6.6 per 1000 suspected typhoid infections (68/10,230). The case-fatality rate was 10% (7/68). Cases sought care later than controls; Compared with 29% (13/45) of TIP cases and 63% (86/137) of controls who sought treatment within 3 days of onset, 42% (19/45) of cases and 32% (44/137) of controls sought treatment 4–9 days after illness onset (ORadj = 2.2, 95%CI = 0.83–5.8), while 29% (13/45) of cases and 5.1% (7/137) of controls sought treatment ≥10 days after onset (ORadj = 11, 95%CI = 1.9–61). 68% (96/141) of cases and 23% (23/100) of controls had got treatment before being treated at the treatment centre (ORadj = 9.0, 95%CI = 1.1–78).ConclusionDelay in seeking treatment increased the risk of TIPs. For future outbreaks, we recommended aggressive community case-finding, and informational campaigns in affected communities and among local healthcare providers to increase awareness of the need for early and appropriate treatment.

Non-traumatic intestinal perforation in the regional hospital Borgou of Benin: epidemiological and therapeutic characteristics

Background: Non-traumatic small bowel perforation is common condition in our income countries. This study aims to determine the pattern of non-traumatic intestinal perforation in our environment.Methods: The demographics, clinical features, relevant investigations, surgery performed and outcome of all the patients confirmed at surgery with intestinal perforation were collected for five years and the data analyzed using version 3.5.1 of Epi Info.Results: Out of the 69 cases involved in this study, there were 46 (66.7%) males and 23 (33.3%) females with a male/female ratio of 2; their mean age was 22.5±13.7 years (range 2 - 68 years). Young people in school constituted 23 (33,34%) of the cases and typhoid intestinal perforation was responsible for 64 (92.8%) cases while ischemic perforation as a result of postoperative flange, strangulated hernia and acute intussusception was responsible in 5 (7.2%) cases. The average duration before presentation in the hospital was 3 days while the average duration between presentation at the hospital and surgery was 2 days. The surgery offered was simple closure after freshening the edges in 35 (50.7%) cases, resection and anastomosis in 28 (40.5%) cases and resection with ileostomy in 6 (8.8 %) cases. The immediate postoperative course was uneventful in 64 (92.8%) case while the mortality was 10 (14.5%). The cause of death was not identified in 3 cases. The average hospital stay was 14.5±12.8 days with extremes of 7 and 55 days.Conclusions: NTIP is relatively common among the causes of widespread acute peritonitis in sub-Saharan Africa and its management remains difficult with high mortality.

Analysis of enteric ileal perforation: a prospective study in a tertiary care hospital

Background: Intestinal perforation as a complication of enteric fever is still a serious problem in developing nations. Enteric ileal perforation is associated with high morbidity and mortality and many patients present in a severe toxic state because of delay in diagnosis and late presentation to hospital.Methods: A prospective study was conducted to assess the prognostic factors in enteric ileal perforation. Observations were made regarding symptoms, signs, duration of illness and presentation of patients to the hospital after acute episode. Per operative findings regarding site, size and number of perforations were recorded. Operative procedures were simple closure, ileostomy, or resection of diseased segment including right hemicolectomy done for associated caecal perforation and entero enteric anastomosis. Post-operative complications like wound infection, wound dehiscence, residual abscess, faecal fistula and deaths were documented.Results: There were 50 enteric ileal perforation cases with a age range of 13-80 with a mean age of 30.7. Male: female ratio was 11: 1. 85% of patients presented within 48 hrs of onset of symptoms of perforation and there is significant mortality in patients who presented more than 48 hrs of onset of symptoms of perforation (57.14%). Mortality was high in multiple perforation group (40%) and also higher incidences of fecal fistula and wound dehiscence.Conclusions: Age and sex have no bearing on the outcome. Perforation presentation interval, delay in surgery, number of perforations are important prognostic markers for typhoid ileal perforation.

A study of clinical profile and management of perforation peritonitis in a tertiary health centre located in Central India

Background: Perforation peritonitis is the most common surgical emergency in India. The spectrum of etiology of perforation in tropical countries continues to be different from its Western counterpart. The objective of the study was to highlight the spectrum of perforation peritonitis as encountered by us at RKDF medical college and research centre, Bhopal, Madhya Pradesh, India.Methods: Our prospective observational study was conducted at Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of August 2013 to August 2015. Total 110 cases of perforation peritonitis were included. Patient detailed history, symptoms, sign, blood investigation finding, cause of perforation, site of perforation, type of surgery, post-operative complications and mortality were assessed and result were compared with other studies.Results: The most common cause of perforation in our series was perforated peptic ulcer (52 cases) followed by typhoid fever perforation (21 cases), appendicular (16 cases) and tuberculosis (11 cases). Despite delay in seeking medical treatment, the overall mortality (16.36%) was comparable with other published series though the overall morbidity (63%) was unusually high.Conclusions: In contrast to western literature, where lower gastrointestinal tract perforations predominate, upper gastrointestinal tract perforations constitute the majority of cases in Central India.

Typhoid Perforation: Presentation and Management Outcome North-Eastern Nigeria

Background: The management of typhoid ilial perforation in this low socioeconomic environment is really challenging because the population is predominantly peasant farmers lacking social amenities and quality water supply. Patients and Methods: The study retrospectively reviewed all patients diagnosed with typhoid perforation and managed in Damaturu and Potiskum district Hospitals North-Eastern Nigeria between January 2012 and December 2016. Results: A total of 279 patients were seen, 268 analyzed and 11 were excluded due to incomplete records. Age ranged from 3 to 50 years with male to female ration of 1.1:1 and a mean of 14.75 years. The peak age group was 11-20 years accounting for 39.93%. The clinical features were abdominal pain in 99.25% and abdominal tenderness in all patients. Procedures done were simple closure of perforation in 87.31% patients, resection and anastomosis in 70.84%. Post-operative complications were surgical site infection in 21.64%, and renal failure in 1.12%. The mortality was 14.18%. Conclusion: Typhoid perforation posed a major health hazard with high morbidity and mortality especially in a low socioeconomic environment where poor personal hygiene, improper human waste disposal, malnutrition, and poor social amenities exist. Despite high mortality associated with the disease, timely diagnosis, aggressive resuscitative measures as well as early surgical intervention can go a long way in reducing menace of the disease. Prevention is the most effective way of reducing this public health problem through health education and provision of adequate potable water.

Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria.

Background:The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion.Patients and Methods:The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16.Results:Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123).Conclusion:DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.

Epidemiological, clinical, and therapeutic features of typhoid intestinal perforation in a rural environment of Burkina Faso.

The aim of this study was to describe the epidemiological, clinical, and therapeutic features of ileal perforation due to typhoid fever at the regional hospital of Tenkodogo (Burkina Faso). This cross-sectional study examined the records over a 5-year period of all patients treated for typhoid ileal perforation. Ileal perforation was diagnosed intraoperatively, and its typhoid origin determined according to the following criteria: background signs of typhoid fever, location of the perforation on the antimesenteric edge of the terminal ileum, and a positive Widal-Felix serology. The study included 216 patients. Their mean age was 13.8years, and 63.4% were male. The average time to consultation was 11days. Clinical signs were mainly abdominal pain, vomiting, and abdominal tenderness. Anemia was observed in 135patients (62.5%). All patients underwent laparotomy. Three procedures for treating surgical perforation were used: excision and suture of the perforation in 86 patients (39.8%), ileal resection with anastomosis in 98 (45.4%), and ileostomy with subsequent recovery in 32 (14.8%). The average length of hospital stay was 16.1days. Postoperative complications occurred in 156patients (72.2%). Thirty-seven patients died, for a mortality rate of 17.1%. Ileal perforations due to typhoid fever are the main cause of peritonitis in rural areas of Burkina Faso. Patients are relatively young, and most are anemic at admission. Morbidity and mortality are significant.

Outcome of primary closure of dirty abdominal wounds in children at the olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria

Background: The management of dirty abdominal wounds has remained a challenge to surgeons because of the associated complications. Objective: This study was undertaken to determine the outcome of primary closure of dirty abdominal wounds in children. Design: A retrospective study (between 1st January, 2006 and 5th May, 2009) on the outcome of the primary closure of dirty abdominal wounds in children. Setting: Paediatric Surgery Division, Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu. Materials and Methods: Cases of dirty abdominal wounds managed during the study period were retrieved from the medical records. Information regarding the age, sex, diagnosis, treatment, type of abdominal wound closure, duration of stay in hospital, complications arising from the abdominal wounds, and outcome was obtained and documented. Results: A total of 120 cases of dirty abdominal wound were managed during the study period. However, 90 case notes were retrieved and further evaluated for the proposed study. The age range of the patients studied was 2 months to 14 years. Males were 48 (53.3%), while females were 42 (46.7%). All the cases were acute abdominal emergencies. Differential diagnosis of dirty abdominal wounds managed during the study period are ruptured appendicitis/appendiceal abscess 30 (33.3%), intussusception 19 (21.1%), strangulated inguinoscrotal hernia 16 (17.8%), typhoid ileal perforation 14 (15.6%), and abdominal injuries 11 (12.2%). Healing without complications was seen in 70 (77.8%) patients, while complications occurred in 20 (22.2%) patients. The complications that occurred were wound infections 17 (68%), wound dehiscence 3 (12%), incisional hernia 3 (12%), enterocutaneous fistula 2 (8%), and duration of hospitalization 7-55 days and mortality of 4 (4.4%) was recorded.

Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria

Primary versus delayed primary closure of laparotomy wounds in children following typhoid ileal perforation in Ile-Ife, Nigeria

A Clinical Profile of Typhoid Perforation of Bowel in a Tertiary Care Centre

&lt;strong&gt;Background and Aims:&lt;/strong&gt; Salmonella typhi causes an estimated 22 million cases of typhoid fever and 216000 deaths annually worldwide1 and in developing countries, typhoid bowel perforation is an important surgical problem. The surgeon is faced with number of challenges during the management of these patients. The aims of this study are 1. To study the clinical profile of typhoid perforation of bowel in a tertiary care centre. 2. To study post operative outcome in patients with typhoid ulcer perforation. &lt;strong&gt;Methods and Methodology:&lt;/strong&gt; A total of 45 patients diagnosed as having typhoid bowel perforation were included for the study after fulfilling the inclusion/ exclusion criteria. &lt;strong&gt;Results:&lt;/strong&gt; Majority of patients were in the 2&lt;sup&gt;nd&lt;/sup&gt; and 3&lt;sup&gt;rd&lt;/sup&gt; decades (57.7%) with age ranging from 18 to 68 years. There were 28 (63.63%) males and 17 (37.7%) females. Fever with abdominal pain were the symptoms in all subjects followed by vomiting, distension of abdomen and constipation respectively. Most of the patients presented during 2&lt;sup&gt;nd&lt;/sup&gt; and 3&lt;sup&gt;rd&lt;/sup&gt; week of illness. 5 patients presented early i.e. within 24 hours and 40 patients presented late i.e., after 24 hours. Widal test was positive in 35 (79.45%) cases. Majority of patients (66.6%) group showed leucocytosis, while 7% showed leucopenia and 17% had normal WBC counts. Single perforation was found in 27 patients (60%), 2 perforations in 14 patients (31.1%) and more than 2 perforations were found in 4 patients (8.8%). Gas under diaphragm was present in all the patients. The most commonly done procedure in 33 cases (73.33% ) was simple closure of the perforation and resection and end to end ileo ileal anastomosis was done in 10 patients whereas ileo transverse anastomosis with ileostomy was done in 2 patients with multiple perforations. The most common post-operative complication was surgical site infection followed by respiratory infections, wound dehiscence. Enterocutaneous fistula was present in one case Mortality rate of 6.6 % was seen.

Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality

Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital.

Profile of intestinal stomas at a tertiary referral centre of central India

Aim: The aim of study was to evaluate various types of stoma with regard to their indications, their complications and methods to reduce them, at a tertiary hospital of central India. Methods: The study was carried out in Department of surgery at M.L.N. Medical College, Allahabad from August 2013 to July 2014. Adult patients who were admitted here and had Ileostomy/colostomy formation/closure as a part of their treatment were included. Data was collected by meticulous history taking, clinical examination and investigations. Results: A total of 100 patients were included (Avg. 34 year) and male: female ratio was 1.6:1. The most common stoma constructed was ileostomy (82%) with loop ileostomy (62%) being the most common subtype. Among colostomies, loop was most common (50%). Main indication of stoma formation was intestinal perforation (63%). In individual causes, Typhoid Perforation (44%) was most common indication. 85% patients had stoma complications, most common being peristomal skin excoriation (80%). Study of closure of stoma was done in a total of 50 patients. Closure of 43 ileostomies and 7 colostomies was done. Mean length of postoperative stay was 11 days. 28% developed complication among which paralytic ileus, (16%) was most common. Conclusion: Despite extensive surgical experience, complications of intestinal stomas still occur frequently and result in high morbidity. Meticulous skin care with regular follow-up, early detection of complications with their timely management along with education and counseling can decrease morbidity.

Surgical management and prognosis of perforation secondary to typhoid fever

Enteric perforation is a serious complication of typhoid fever and the condition has a high morbidity and mortality in many developing countries including India. No consensus exists concerning the best procedure to be performed in these cases. Aim: The purpose of this study was to analyse our clinical experience in surgical management of enteric perforation and to determine the prognostic factors associated with morbidity and mortality. It was a prospective study of patients who underwent surgery for typhoid intestinal perforation at SMS Medical College and Hospital, Jaipur, India, between April 2012 and October 2013. Laparotomy was performed by a midline incision. Management of perforation was based on the intraoperative findings and the procedure to be performed was decided by the operating surgeon. 88 patients were studied with a male to female ratio of 6.3:1. The mean age was 36.4 years. The peak incidence was between 21 to 30 years. All the patients presented with abdominal pain and distension. More than 90% patients showed free gas under diaphragm. 71% patients had a single perforation and 97% patients had perforations confined to ileum. Debridement with double layered closure was performed in about 58% patients, ileostomy in 25% and resection anastomosis in 18% of patients. Overall complication rate was 44.3% with surgical site infection being the most common morbidity. The mortality rate was 17.1% which was significantly affected by perforation-admission interval of more than 48 hours, number of perforations and occurrence of postoperative complications. Typhoid fever leading to development of intestinal perforation continues to be a significant health problem with a high morbidity and mortality especially in rural India. The management of the disease requires an early and appropriate surgical intervention.

English

English

Ileostomy in Typhoid Perforation

This is a prospective observational study carried out during last five years (Jan, 1998 to Nov, 2002) The purpose was to study guidelines of case selection for different available procedures to treat typhoid perforations. Ninety cases of typhoid perforation were treated by different procedures. The complete records were maintained and a designed protocol of management was observed. Male to Female ratio was 4 to 1. Average age 26 years (7 cases below 10 years and 6 cases above 40 years) Only 17 cases (18.88%) presented within 24 hours, the largest group of 31 cases (34.44%) presented after 72 hours. Although complication rate was very high in the late reporting, no significant mortality difference was noted. Primary ileostomy (group 1) 18 cases had no mortality, 53 cases of simple perforation closure had 5 mortalities (9.43%), resection anastmosis group that is 19 cases had 2 mortalities (10.5%), closure of the ileostomies (19 cases) had no mortality and a very low complication rate. In our study ileostomy is a good life saving procedure to be used judiciously, accepting its inconvenience to the patient.

Primary repair vs ileostomy in patients with typhoid perforation

This is prospective study conducted in the department of Surgery, Mayo Hospital, Lahore over the period of four years. Comparative data was compiled on 100 patients divided in two equal groups. Efficacy of two operations was assessed in terms of morbidity and mortality. The final results were conclusive enough to show the benefits of ileostomy over the primary repair in cases of typhoid perforation.