TO DETERMINE THE TYPHOID ENTERIC PERFORATION PROGNOSTIC FACTORS

Objective: To analyze and estimate the importance of various factors in typhoid enteric perforation in a surgical unit. Study Design: A Case Series. Place and Duration: In the Surgical Unit II of Services Hospital Lahore for One year duration from February 2018 to February 2019. Methodology: This study was performed in sixty-two patients clinically diagnosed with typhoid perforation. The diagnosis was mainly clinical and the Widal test was completed with radiological findings of free gas under the diaphragm and operative findings of ileal perforation at the anti-mesenteric border. All patients underwent exploratory laparotomy after adequate resuscitation. Operative findings were observed, the amount of pus and discharged fecal material was calculated and perforation was excluded as ileostomy. Postoperative results were closely monitored and data of each patient was entered into a form. Results: Fifty (80%) patients were male and twelve (20%) patients were female. Fifty-two patients (84%) had single perforation and ten patients (16%) had multiple perforations. Fifty (80%) patients developed postoperative complications such as wound infection, ruptured abdomen, residual intraabdominal abscess, septicemia and fecal fistula. Age and sex had no effect on prognosis. Late presentation, delayed surgery, multiple perforations, and abundant discharge of pus and fecal material from the peritoneal cavity adversely affected mortality. Overall mortality rate was 17.7% (11/62). Conclusion: Mortality, duration of disease, duration of operation and perforation, multiple perforation, abundant peritoneal fluid, septicemia, fecal fistula and abdominal rupture are significantly affected by typhoid perforation; some survivors with fecal fistula and wound infection remain in hospital for a long time. Key Words: Enteric perforation, mortality, prognostic factors, typhoid