Is operative management effective in treatment of perforated typhoid?

Saxe, Jonathan M.; Cropsey, Robert

doi:10.1016/j.amjsurg.2004.11.032

Cited by 51 publications

(58 citation statements)

References 7 publications

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“…Typhoid enteric perforations were managed by either primary repair or only stoma, depending on the condition of the gut and general condition of the patient and also managed laparoscopically [24]. Primary repair of the typhoid perforation is a safe and effective treatment [25]; as seen in our study, 26 % patients were managed by primary repair.…”

Section: Discussionmentioning

confidence: 58%

Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience

Yadav

Garg

2012

Indian J Surg

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Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well in India. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counterpart. This study was conducted at Hindu Rao Hospital, Municipal Corporation of Delhi, New Delhi, India, designed to highlight the spectrum of perforation peritonitis in the eastern countries and to improve its outcome. This prospective study included 77 consecutive patients of perforation peritonitis studied in terms of clinical presentations, causes, site of perforation, surgical treatment, postoperative complications, and mortality at Hindu Rao Hospital, Delhi, from March 1, 2011 to December 1, 2011, over a period of 8 months. All patients were resuscitated and underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (26.4 %) and ileal typhoid perforation (26.4 %), each followed by small bowel tuberculosis (10.3 %) and stomach perforation (9.2 %), perforation due to acute appendicitis (5 %). The highest number of perforations was seen in ileum (39.1 %), duodenum (26.4 %), stomach (11.5 %), appendix (3.5 %), jejunum (4.6 %), and colon (3.5 %). Overall mortality was 13 %. The spectrum of perforation peritonitis in India continuously differs from western countries. The highest number of perforations was noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. The most common cause of perforation peritonitis was perforated duodenal ulcer and small bowel typhoid perforation followed by typhoid perforation. Large bowel perforations and malignant perforations were least common in our setup.

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Section: Discussionmentioning

confidence: 58%

Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience

Yadav

Garg

2012

Indian J Surg

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“…Typhoid enteritis continues to be a significant cause of morbidity and mortality in children worldwide, especially in developing countries [1][2][3]. Acquired by the faeco-oral route, typhoid enteritis is endemic in areas with poor socioeconomic facilities, including poor water supply and sanitary systems [4,5].…”

Section: Introductionmentioning

confidence: 99%

Typhoid intestinal perforation in children: a continuing scourge in a developing country

et al. 2006

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Typhoid intestinal perforation is a principal cause of morbidity and mortality affecting both adults and children. This study aims to evaluate the pattern of typhoid intestinal perforation and outcome of its management in Nigerian children. The records of consecutive children managed for typhoid intestinal perforation at Juth, between 1996 and 2005 have been reviewed. There were 184 children (M:F = 1.04:1), with a mean of 5.8 years (range 4 to 15 years). More than a half (62.5%) of the patients were in the 5-6 year age group. The incidence peaked in April-May, and November-December. Increased incidence of typhoid perforation was observed between 2002 and 2005. All patients presented with the classic features of typhoid enteric perforation. Hypokalaemia and anaemia were common at presentation. Only 75 (40.6%) patients had operation within 24 h of perforation. The types of surgery included simple excision of the edges of the peroration and closure (74.5%), wedge resection and closure in (14.5%), segmental resection with primary end-to-end anastomosis (3.6%) and right hemi-colectomy with ileo-colic or ileo-transverse anastomosis. Wound infection and dehiscence, anastomotic breakdown with faecal fistula, intra peritoneal abscesses and chest infections were the main post operative complications. The overall mortality rate was 22.8 (42). Excision and simple closure was associated with the least incidence of anastomotic breakdown and operation time. The incidence of typhoid intestinal perforation is on the increase at our institution. Early limited surgery provides optimal results.

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“…Koume et al, reported high mortality due to complications related to ileostomy [28]. Saxe et al, attributes mortality in his study to persistent sepsis which he says could have been prevented by using broad spectrum antibiotics [29]. There was no mortality in our study probably due to early and appropriate surgical intervention, effective pre and peri-operative resuscitation, post-operative intensive care procedures, good ileostomy care and delivery of broad spectrum antibiotics.…”

Section: Discussionmentioning

confidence: 50%

Journal of Clinical and Diagnostic Research. 2013 Sept, Vol-7(9): 1946-1948 1946 1946 DOI: 10.7860/JCDR/2013/6632.3366 Original Article

Pujar¹

2013

JCDR

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Background: Typhoid fever is an important public health problem in developing countries. Intestinal perforation is one of the leading fatal complications of typhoid fever. Typhoid perforation occurs more commonly in terminal ileum. Morbidity and Mortality associated with typhoid perforation are high (9-22%). However this study aims to know whether there are any changes of the same. Aim:To analyse the clinical presentation, management, complications, morbidity and mortality associated with typhoid intestinal perforation and assess changing trends in mortality in typhoid intestinal perforation. Material & Methods:This is a retrospective observational study. Cases regarding the study have been analyzed by reviewing the patient records. It includes 40 patients who were diagnosed with typhoid intestinal perforation, admitted and treated in the Department of General Surgery from February 2011 to January 2012.Results: A total of 40 patients were considered for the study and their mean age was 35.75 years. 80% of patients were male. Pain abdomen was their main symptom which lasted for an average of 2.95 days. Leukocytosis (11,000 cells/cumm) was present in 57.5% patients. Single perforation was present in 31(77.5%) patients and primary closure was done in 30 of them. Culture sensitivity showed E coli as the main organism. Complications were seen in 42.5% of patients in post-operative period. Conclusion:Early recognition, timely surgical intervention with appropriate surgery and antibiotics, and effective peri-operative care reduces the mortality in typhoid intestinal perforation.

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Is operative management effective in treatment of perforated typhoid?

Cited by 51 publications

References 7 publications

Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience

Spectrum of Perforation Peritonitis in Delhi: 77 Cases Experience

Typhoid intestinal perforation in children: a continuing scourge in a developing country

Journal of Clinical and Diagnostic Research. 2013 Sept, Vol-7(9): 1946-1948 1946 1946 DOI: 10.7860/JCDR/2013/6632.3366 Original Article

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