Role of gum chewing on the duration of postoperative ileus following lleostomy closure done for typhoid ileal perforation: a prospective randomized trial

There is ample evidence in the recent literature that gum chewing after elective colonic anastomosis decreases postoperative ileus [POI]. But there are very few studies on small bowel anastomosis done in relaparotomy cases. This study aimed to evaluate the effect of gum chewing on the duration of POI following small bowel anastomosis performed for the closure of intestinal stoma, made as temporary diversion in the selected cases of typhoid perforation peritonitis. Hundred patients undergoing elective small bowel anastomosis for the closure of stoma were randomly assigned to the study group [n=50] and the control group [n=50]. The study group patients chewed gum thrice a day for 1 h each time starting 6 h after the surgery until the passage of first flatus. The control group patients had standard postoperative treatment. Study and control group patients were comparable at inclusion. The mean time for the appearance of bowel sounds as well as the passage of first flatus was significantly shorter in the study group [P=0.040, P=0.006]. The feeling of hunger was also experienced earlier in study group cases [P=0.004]. The postoperative hospital stay was shorter in the study group, but the difference was not significant [P=0.059]. The cases of relaparotomy requiring additional adhesiolysis and small bowel anastomosis for stoma closure are benefited by postoperative gum chewing

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Background: Abdominal wounds following surgery for typhoid perforation are classified as dirty; with an infection rate of over 40. To date; the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice; is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife; Nigeria; and advocates a multidisciplinary wound management protocol. Patients and Methods: This is a retrospective study of children aged 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria; over a period of ten years. Results: Thirty-two patients; 18 males and 14 females; in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8) patients; while 19 (59.4) patients had surgical site infections. Wound dehiscence; intraabdominal abscess; and faecal fistulas were the other complications documented in the study. Conclusion: Abdominal wounds of typhoid perforation; though classified as being dirty; can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs

Comparison between primary repair and exteriorization in cases typhoid perforation

This comparative study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of typhoid perforation 80 patients were selected out of which 48 were males and 32 were females. Consisted of a history of fever abdominal pain, constipation, sharp shooting pain superimposed over the colicky abdominal pain clinical finding included tense tender abdomen and absent bowel sounds, investigations including gas under diaphragm in abdominal x-ray and positive widal test. Consisted of negative Widal test even if there was gas under diaphragm, per op findings suggestive of tuberculosis or histopathology reports suggestive of tuberculosis or any pathology other than typhoid. Primary repair was done in patients who presented within 36 hrs of experiencing sharp shooting pain and per op findings of minimal contamination. Exteriorization in the form of loop or double barrel ileostomy was done in other cases

Perforación tífica / Typhoid ileal perforation

Propósito: La Fiebre Tifoidea es una enfermedad endémica en nuestro país. La perforación ileal representa una complicación abdominal seria. Decidimos documentar nuestra experiencia con pacientes que sufrieronperforación intestinal tífica en el Departamento de Cirugía del Hospital Roosevelt. Métodos: Se revisaron los expedientes médicos de 67 pacientes tratados por perforación tífica. El período de estudio fue de ll años y estuvo comprendido entre enero 1988 y diciembre de 1998. Se documentó la sintomatología gastrointestinal que causó la hospitalización, haciéndose énfasis en el tiempo de evolución de la enfermedad hasta el tratamiento quirúrgico final, incluyéndose: segunda vista, reintervención no planeada, morbilidad y mortalidad. Los resultados fueron analizados mediante las siguientes pruebas: Chi cuadrado, Exacta de Fisher y Razones de probabilidad (Odds Ratio). La significancia estadística se determinó con p<0.05). Resultados:Fueron 46 hombres y 21 mujeres con rango de edad entre 13 y 30 años. Los hallazgos clínicos más comunes fueron: fiebre, distensión y dolor abdominal. La contaminación severa del abdomen se asoció con mayor mortalidad (p<0.05).La reintervención quirúrgica para las perforaciones intestinales también se asoció con mayor riesgo de muerte debido a la sepsis (p=0.04) y alto grado de morbilidad (p=0.0001). La morbilidad postoperatoria fue de 35 por ciento y la mortalidad 12 por ciento. Conclusiones: Factores de riesgo probables que contribuyen a la morbilidad y mortalidad postoperatoria son: tiempo de evolución de la enfermedad hasta el tratamiento quirúrgico inicial, número de perforaciones, contaminación severa y reperforación. La pobre calidad de vida y el estado nutricional de los enfermos fueron factores adicionales que afectaron directamente los resultados de la investigación

Typhoid ileal perforations: a study of 75 patients

The results of surgical treatment of 75 cases of typhoid ileal perforation are presented. Fifty-eight% of the patients were between 20 and 40 years of age. Seventy-five% of the patients were seen after an illness of 2-4 weeks. Most of the patients reported late to the hospital so upto 72% of the patients were explored 24 hours after the perforation occurred. At operation the peritoneal cavity was full of pus and small bowel contents. More than 85% of the perforations were located within 60cm from ileocecal valve. Only 16% patients had multiple perforations. Thirty-eight patients [50.7%] underwent simple closure of their perforations. Nineteen patients [25.3%], underwent wedge-excision of the ulcer and 2-layer closure and eighteen [24%] underwent exteriorization of the perforation as an ileostomy, mostly because of multiple perforations. Peritoneal toilet with warm saline was performed in all patients. The overall mortality was 12%. Chloramphenicol, genticyn and metronidazole were used in combination in all the patients. We recommended early limited surgery to improve results

Cirugía de la perforación intestinal tífica / Surgery of the typhoid intestinal perforation

La perforación intestinal tífica con una frecuencia menor de 1 por ciento , es la complicación quirúrgica mas importante de la fiebre tifoidea y presentó en el pasado una alta mortalidad. Este estudio se realizó en 53 pacientes portadores de una perforación intestinal tífica, en los cuales se practicó una resección en cuña en 38, resección intestinal en 8 y sutura intestinal simple en 7 pacientes. Se observó una mortalidad de 1,9 por ciento y una morbilidad quirúrgica (50,9 por ciento ) que correspondió a infección de herida operatoria en 18 pacientes, dehiscencia de sutura en 5, absceso residual intraabadominal en 3 pacientes, evisceración total de herida operatoria en 2 y necrosis de ileostomía en 1 paciente. Los mejores resultados se obtuvieron con resección en cuña

Role of surgery in typhoid perforation

Thirty patients were admitted during the period 1980 till 1987 with perforation due to typhoid fever. Five patients were treated conservatively and 25 patients were subjected to operation with different procedures according to the general condition of the patient. Mortality and morbidity were much better after surgery