A Clinical Study of Prognostic Factors in Peritonitis Secondary to Hollow Viscus Perforation: In a Tertiary Hospital

Abstract

BACKGROUND AND OBJECTIVES Typhoid ileal perforation is a common problem seen in tropical countries. Over the years, advances in the treatment of typhoid fever has decreased the incidence of typhoid ileal perforation. This study is conducted to throw a light on prognostic factors in the surgical outcome of typhoid ileal perforations. METHODOLOGY Fifty consecutive patients clinically diagnosed as having typhoid ileal perforation was taken for the study over a period of 18 months from November 2011 to May 2013. Pre-operative patients were investigated for the air under the diaphragm using upright chest X-ray and erect abdomen X-rays. Blood culture and Widal tests were done to diagnose the patients that they were suffering from typhoid fever. Patients with general peritonitis due to other causes excluded from the study. RESULTS Out of 50 patients, there were 40 (80%) males and 10 (20%) females, thus the male:female ratio was 4:1. Their ages ranged from 16-58 years. There were 32 patients presented early and 18 patients presented lately. The patients presented to the hospital with spectrum of symptoms. All the patients had pain abdomen to present with, out of which 29 patients had fever, 33 had dehydration and 16 had shock on presentation. In these 50 patients, 33 patients had single perforations and 17 had multiple perforations. The single perforation was treated with simple closure and resection anastomosis was done in cases of multiple perforations. The patients were observed for complications of surgery. The mean hospital stay was 13.28 days. We lost 6 cases. There were 19 cases of wound infection, 12 cases of wound dehiscence, 7 cases of enterocutaneous fistula, 4 cases of respiratory tract infections. The blood culture was positive in 4 cases and the culture yielded Salmonella typhi. The Widal test was positive in 44 cases. There were 13 cases of abdominal fluid culture positive. All yielded the growth of E. coli. CONCLUSION Typhoid ileal perforation is one of the most common surgical emergency encountered by the general surgeon. Widal test is still useful in the diagnosis of typhoid fever in our country. The number of perforations and the peritoneal contamination and the delay in getting medical facility-surgery, shock at the time of presentation at hospital are directly proportional to the morbidity and mortality. Availing early medical facility, which is a modifiable risk factor. If timely early medical attention is sought, majority of morbidity and mortality can be tackled.