Surgical management of typhoid ileum perforations: a systematic review

Background: Typhoid is a disease caused by a gram negative bacterium Salmonella typhi. Prolonged infection leads to necrosis in the Peyer's patches of the antimesenteric border of bowel leading to intestinal perforation. Various surgical procedures have been described for the treatment of these perforations. Typhoid intestinal perforations are still associated with high case fatality rates averaging 15.4%. Objective: To identify current surgical management options for typhoid ileal perforations and to describe the best surgical management in relation to mortality and complications. Methods: A systematic review was done using PRISMA guidelines. Common search terms used were typhoid perforation/typhoid ileal perforation management. A narrative synthesis of the findings from the included studies structured around the type of intervention, target population characteristics, types of outcome and intervention content was done. Results: Primary closure of ileal perforations was the most commonly performed procedure. Ileostomy is the choice of surgery for severe abdominal contamination and when the patient has poor general health. Most studies found mortalities and complications to be unrelated to surgical procedure done. Mortality was significantly associated with the number of perforations and abdominal contamination. Conclusions: Individual studies support particular surgical interventions but the review showed that complications and mortality are not related to the type of surgical intervention alone but to a number of other non-surgical factors. There is need for further level 1 studies on this topic