DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20164493

Retrospective case control study on typhoid and non-typhoid small bowel perforation

Sandeep Mahapatra, Charan Panda

Abstract


Background: Out of several causes of small bowel perforations, Typhoid is the commonest cause in tropical countries claiming a higher morbidity and mortality profile. In Spite of conducting a good clinical examination and a battery of investigatory procedures, the etiology of perforation still remains obscure in a good number of cases. This retrospective case control study was conducted with an objective to evaluate the causes of small bowel perforation and to compare the surgical procedures and the outcomes in patients of typhoid and non-typhoid small bowel perforations.

Methods: This study was based on hospital records for the last 3 years from April 2003 to April 2006. All the cases that were admitted with perforations had undergone a battery of tests to rule out the causes. 69 patients had one or the other test positive for typhoid (cases); the other causes of perforation were taken as control (n=43).

Results: In typhoid perforations, although none of the operative procedures are clearly advantageous over the other, but anastomoses including the by-pass procedures are associated with more of complications wound dehiscence (p value 0.004), anastomotic leakage (p value 0.04), intra-abdominal collections (p value 0.009) with a longer hospital stay and hence to be avoided as practicable.

Conclusions: Typhoid ileal perforation still has a poor prognosis with high morbidity and mortality. Late presentation, delayed surgery, multiple perforations, severe peritoneal contamination, and post-operative faecal fistula are factors that have an adverse effect on mortality. Most deaths occur during the early post-operative period, with survivors having a prolonged hospital stay.


Keywords


Anastomosis, Bypass, Non typhoid small bowel perforation, Typhoid

Full Text:

PDF

References


Van Der Werf TS, Cameron ES. Typhoid perforation of the ileum: a review of 59 cases seen at Agogo hospital, Ghana between 1982 and 1987. Trop Geogr Med. 1990;42:330-6.

Maurya SD, Gupta HC, Tiwari A, Sharman BD. Typhoid bowel perforation: A review of 264 cases. Int Surg. 1984;69:155-8.

Butler T, Knight J, Nath SK, Speelman P, Roy SK, Azao MAK. Typhoid fever complicated by intestinal perforation: a persisting fatal outcome requiring surgical management. Rev Infect Dis. 1985;7:244-56.

Bitar F, Tarpley Y. Intestinal perforation in typhoid fever: Historical and State of Art Review. Infect Dis. 1985;7:257-71.

Parry EHO. Typhoid Fever. In: Parry EHO, ed. Principles of Medicine in Africa, 2nd edn. Oxford: Oxford University Press. 1984:268-76.

Archampong EQ. Typhoid Ileal Perforation: Why Such Mortality. BrJ Snrg. 1976;63:317-21.

Olurin FO, Ajaji OO, Bohrer SP. Typhoid perforation. J Coll Surg Edinb. 1972;17:253-63.

Ajao OG. Typhoid perforation: factors affecting mortality and morbidity. Int Surg. 1982;67:317-9.

Adesunkanmi ARK, Ajao OG. The prognostic factors in typhoid ileal perforation: a prospective study of 50 patients J. R. Coll. Surg. Edinb. 1997;42:395-9.

Beniwal U, Jindal D, Sharma J, Shyam G. comparative study of procedures in typhoid perforationsd. Indian J Surg. 2003:65:172-7.

Duthie R, French GL. Comparison of methods for the diagnosis of typhoid fever. J Clin Pathol. 1990;43:863-5.

Santillana M. Surgical complications of typhoid fever. World J Surg. 1991;15:170-5.

Jasudason M, Esther E, Mathai E. Typhoid test to detect IgG and IgM antibodies in typhoid fever. Indian J Med Res. 2002;116:70-2.

Dixon JM, Lamusden AM, Paris J. Small bowel perforation. JR Coll Surg Edinb. 1985;30(1):43-6.

Chaikot H. Non-traumatic perforation of small bowel. Am J Surg. 1987;153:355-8.

Nadkarni KM, Shetty SD, Kagzi RS, Bhalarao RA. Small bowel perforation. A study of 32 cases. Arch Surg. 1981;116:53-7.

Karmarkar SR, Trivedi DR, Bhalarao RA. Perforations of terminal ileum. Indian J Surg. 1972;34:422-6.

Archampong EQ. Tropical disease of small bowel. World J Surg. 1985;9:887-96.

Kim JP, Seung Keur OH, Jarrett F. Management of ileal perforation due to typhoid fever. Ann Surg. 1975;181(1):88-91.

Archampong EQ. Typhoid ileal perforations. Why such mortalities. Br J Surg. 1976;63:317-21.

Meier DE, Imediogwu OO, Tarpley JL. Perforated typhoid enteritis: Operative experience with 108 cases. Am J Surg. 1989;157:423-7.

Mock CN, Amaral J, Visser LE. Improvement in survival from typhoid ileal perforation. Ann Surg. 1992;215(3):244-9.

Khana AK, Mishra MK. Typhoid perforation of the gut. Postgrad med J. 1984;6:523-5.

Mckeena JP, Currei DJ, Macdonald IA, Mahoney LI, Filayson HC, Lankasali IC. The use of continuous postoperative peritoneal lavage in the management of diffuse peritonitis. Surg Gynecol Obstet. 1970;130:254-8.

Badejo OA, Arigbabu AO. Treatment of typhoid perforation with peritoneal irrigation: A comparative study. GUT. 1980;21:141-5.

Welch TP, Martin NC. Surgical treatment of typhoid perforation. Lancet. 1975;1:1078-80.

Eggleston FC, Santoshi B, Singh CM. Typhoid perforation of bowel. Ann Surg. 1979;190:31-5.

Lizarralde E. Typhoid perforation of the ileum in children. I Ped Surg. 1981;16:1012-6.

Gibney El. Typhoid enteric perforation in Rural Ghana. I Jr CoIl Phys Surg. 1988;17:105.

Ajao OO, Ajao AO. "Idiopathic" intraabdominal abscess. Trans R Soc Trop Med Hyg. 1982;76:75-6.

Keenan JP, Hadley GP. The Surgical Management of Typhoid Perforation in Children. Br J Surg. 1984;71:928-9.

Adeloye A. Typhoid Fever. In: Adeloye A, ed. Davey’s Companion to Surgery in Africa, 2nd edn. Edinburgh: Churchill Livingstone. 1987:309-16.