Choice of Surgical Procedures in Enteric Fever: A Study

Typhoid fever is a severe febrile illness caused primarily by the gram negative bacillus Salmonella enteritidis serovar Typhi. The most lethal complication of it is bleeding and ileal perforation, both arising from necrosis of Peyer’s patches in the terminal ileum. The present study was conducted in 172 adult patients of Typhoid perforation admitted in 2008- 2013 treated surgically. The aim of the study to show simple repair of perforation is the justified surgical procedure in terms of morbidity, mortality and cost effectiveness. Duration of perforation, number of perforation and development of faecal fistula are the factors which significantly affect mortality. Primary temporary ileostomy and ileo transverse anastomosis were performed in some patients with multiple perforations and/or with perforation situated near/on the ileocaecal junction having greater risk of “repair leak”. Resection and anastomosis is considered in some cases of multiple perforations and unhealthy gut with or without defunctioning ileostomy. Common post-operative complications include wound infection (17%), bleeding (1.16%-2 cases out of 172), faecal fistula (2.9%-5 cases out of 172) and skin excoriation around ileostomy (6.4%). Key words- Typhoid perforation, repair of perforation, primary ileostomy, repair with ileo transverse anastomosis