Perforation operation interval as a prognostic factor in typhoid ileal perforation

ABSTRACT

To find out significance of perforation-operation interval [POI] in relation to early prognosis in patients with peritonitis due to typhoid Heal perforation [TIP]. Case series. Department of General Surgery, Jinnah Postgraduate Medical Centre [JPMC] Karachi, from October, 2004 to March, 2007. The study included 92 patients with generalized peritonitis diagnosed as typhoid Heal perforation Methods fulfilling the inclusion criteria. All non typhoidal and traumatic perforations were excluded from the study. Data was collected in the proforma designed for the study. The diagnosis of typhoid Heal perforation was established on the basis of history, clinical examination, radiology, isolation of Salmonella Typhi, and a positive Widal test. Histopathological confirmation of the diagnosis was also made. Out of 92 patients, 75 were males [81.5%] and 17 [18.5%] females, with male to female ratio of 4.41. The ages ranged between 15 to 50 years. The most common symptoms were fever [100%], abdominal pain [100%], constipation [81.5%], vomiting [76%] and distension of abdomen [69.5%]. The most common signs elicited on abdominal examination were tenderness [100%], guarding [72.8%] and absent gut sounds [65.2%] Out of 92 patients 12 patients [13%] presented within 24 hours of onset of severe abdominal pain [Group A]. Among late presenters, My nine [64.1%] patients presented 25-72 hours after severe abdominal pain [Group B] and twenty one patients [23%] presented after 72 hours [Group C]. Mortality was highest among group C patients [8/21 ;38%], while the mortality among the late presenters [Group B] was 10.2% [6/59]. There r was no mortality in the early presenters [Group A]. Overall mortality was 15.2% [14/92]. The average perforation operation interval in survivors was 44.2 hours as compared to average of non-survivors- 63.9 hours [p <0.01]. Prolonged presentation time leads to a high mortality rate. Once intestinal perforation occurs, early recognition, early referral and aggressive management could decrease the high mortality