Typhoid perforation: An Experience at Mayo Hospital, Lahore

Abstract

With the view of evaluating our own results with pertinent emphasis on surgical treatment, we conducted this retrospective study. This study consists of 53 cases of typhoid perforation treated in our unit in the last two calendar years from Jan 1997 to Dec. 1998. We found that disease remains endemic in poor socioeconomic areas and usual sufferers are young active males(71.7%), with male to female ratio of 2.5:1. The diagnosis of the typhoid perforation should be made on physical examination, prolonged fever 02-03 weeks (62.2%) followed by pain abdomen usually 24-72 hours (68%). The diagnosis is supported by pneumoperitoneun in. 37(68.9%), the serological tests are neither very specific nor readily available in emergency laboratory. The surgical treatment is required in all cases. The majority of the patients had single perforation 39(78%), multiple in 07(14%) and mostly had established severe peritonitis 34(68%). The single layer repair was performed in 18 (36%), double layer in 21(44%) which carries risk of leakage 01(5.5%) and 02(9.5%) respectively. Resection and anastomosis was performed in 10(20%) cases which resulted in very high morbidity and mortality 03(30%). Wound infection was the commonest complication, leakage was seen in 06 (12%) cases, incidence of leakage was minimum with single layer closure of perforation. The flouroquinolone are far superior with response rate of 92.3% as compared to chloramphenicol 66.6%. Hence single layer closure with aggressive peritoneal lavage under flouroquinolone is recommended. Exteriorization should be preferred choice than resection and anastomosis in high risk cases.