Multiple ileal perforations and concomitant cholecystitis with gall bladder gangrene as complication of typhoid fever

Pandove, Paras Kumar; Moudgil, Ashish; Pandove, Megha; Aggarwal, Kamna; Sharda, Divya; Sharda, Vijay K.

doi:10.1093/jscr/rju070

Cited by 10 publications

(16 citation statements)

References 6 publications

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“…Involvement of Peyer’s patches of small intestine with hyperplasia, necrosis and ultimately bleeding, perforation and peritonitis in the third or fourth week of infection is one of the dreaded complications. Perforations can be multiple, require resection of entire segment and are associated with high mortality [ 13 , 17 - 19 ]. Fortunately none of our patients suffered the harrowing complications of GI bleeding, abdominal abscess, or perforation.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal and Hepatobiliary Complications of Extensively Drug-Resistant Typhoid at a Tertiary Care Hospital in Pakistan

Mansoor¹,

Ahmed²,

Fida³

et al. 2020

Cureus

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Introduction: Typhoid fever is a major health problem in developing countries. Extensively drug-resistant (XDR) typhoid is an emerging threat to world health. The objectives of this study were to report our blood culture proven patients having XDR typhoid and compare the rate of gastrointestinal (GI) and hepatobiliary manifestations and complications of antimicrobial sensitive and resistant strains. Materials and methods: This prospective observational study was carried out at a tertiary care hospital in Pakistan, from January 2019 till August 2020 on all consecutive blood culture proven patients of Salmonella typhi. A total of 57 cases of Salmonella were identified, of which 10 were nonresistant, seven multi drugresistant (MDR), 39 extensively drug-resistant (XDR), and one was extended-spectrum beta lactamase (ESBL) positive. Alarmingly, one of the S. typhi isolate in addition to the first line drugs, was also resistant to azithromycin. Patients were treated with antibiotics according to antimicrobial susceptibility of the Salmonella in accordance with the World Health Organization (WHO) and Medical Microbiology and Infectious Diseases Society of Pakistan (MMIDSP) guidelines and GI and hepatobiliary complications were recorded. Results: Overall rate of complications was low. Some 10% (1/10) with nonresistant typhoid, 14% (1/7) with MDR, and 15% (6/39) of our patients with XDR typhoid fever had abdominal tenderness (p=0.95). None of the patients had GI bleeding, abdominal abscess, or peritonitis. Some 20% (2/10) patients with nonresistant typhoid, 29% (2/7) with MDR, and 18% (7/39) with XDR typhoid developed acute hepatitis, with greater than three times elevation of liver transaminases. There was no statistically significant difference in the occurrence of hepatitis between these groups (p=0.98). Interestingly, one of our patients with XDR typhoid also developed cholestatic hepatitis. Conclusion: There is no significant difference in GI and hepatobiliary complications amongst antimicrobial sensitive and resistant strains of typhoid. However, emergence of resistant strains calls for focus on prevention and judicious use of antimicrobials.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal and Hepatobiliary Complications of Extensively Drug-Resistant Typhoid at a Tertiary Care Hospital in Pakistan

Mansoor¹,

Ahmed²,

Fida³

et al. 2020

Cureus

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“…5 Previous reports have shown that complicated acalculous cholecystitis can occur in concordance with bowel complications though this could not be confirmed in this patient. 9 Indications for cholecystectomy in children with acute acalculous cholecystitis are gallbladder complications like perforation, empyema, and gangrene commonly seen in patients with systemic bacterial infections. 10 Surgery was the treatment of choice in this patient; however due to difficulties in dissection of Calot's triangle, we opted to do a subtotal cholecystectomy with nonclosure of the cystic duct and subhepatic drainage.…”

Section: Discussionmentioning

confidence: 99%

Subtotal cholecystectomy: An operative option for Salmonellae typhi gangrenous cholecystitis

Akello

Bitamazire

Wandabwa

et al. 2020

Clinical Case Reports

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“…The most reported complications are intestinal perforations, gastrointestinal bleeding, parotitis, genitourinary infections and hepatobiliary infections [6,7,15]. Some complications respond to medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Complications of typhoid fever in digestive surgery: a descriptive study based on 295 cases in a sub Saharan environment

Ouédraogo

Ouangré

Zida

et al. 2019

Preprint

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Background: Typhoid fever is endemic in sub-Saharan Africa. Inadequate management often leads to complications, which are mainly surgical. Surgical complications are fraught with heavy mortality. Objective: To describe the surgical and digestive complications of typhoid fever in the Surgical Department of Tenkodogo Regional Hospital in Central-Eastern Burkina Faso. Methods: This was a descriptive study performed in the digestive surgery department of Tenkodogo Regional Hospital. It covered the period from January 2014 to December 2018. The records of all patients who were admitted for a surgical complication of typhoid fever were included. Results: Two hundred and ninety-five patients were treated for a surgical complication of typhoid fever. There were 184 male patients (62.4%) and 111 female patients. Their average age was 15.7 years. The reported complications were peritonitis by ileal perforation with 212 cases (71.2%), acute cholecystitis with 45 cases (13.8%), primary biliary peritonitis with 23 cases (6.8%) and liver abscess with 15 cases (5.1%). Patients were operated on by laparotomy and laparoscopy under general anaesthesia. The ileal perforations were treated according to 3 surgical procedures: excision-suture of the perforation, resection-anastomosis at the same time and ileostomy with restoration of the digestive continuity after 3 weeks. In cases of acute cholecystitis or biliary peritonitis, a cholecystectomy was proposed. The liver abscesses were drained by laparotomy or by puncture. Antibiotic therapy was associated with surgical treatment. The average length of stay of patients was 9 days. Twenty-eight patients died, which represents 9.5% mortality. Conclusion: The surgical complications of typhoid fever are responsible for heavy mortality in digestive surgery.

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Multiple ileal perforations and concomitant cholecystitis with gall bladder gangrene as complication of typhoid fever

Cited by 10 publications

References 6 publications

Gastrointestinal and Hepatobiliary Complications of Extensively Drug-Resistant Typhoid at a Tertiary Care Hospital in Pakistan

Gastrointestinal and Hepatobiliary Complications of Extensively Drug-Resistant Typhoid at a Tertiary Care Hospital in Pakistan

Subtotal cholecystectomy: An operative option for Salmonellae typhi gangrenous cholecystitis

Complications of typhoid fever in digestive surgery: a descriptive study based on 295 cases in a sub Saharan environment

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