Selective management of typhoid perforation of bowel

ABSTRACT

To evaluate the selective management of enteric typhoid perforation, according to the time of presentation, in terms of morbidity and mortality. Descriptive case series. Surgical unit of DHQ teaching hospital, Rawalpindi, from April 2004 to April 2011. A total of 84 patients were included, and divided into two groups. Forty patients, who presented early [within 48 hours] constituted group A, were managed by primary closure. of perforation while patients who presented late were put in group B and stoma was made. The age range was 10 to 40 years. Seventy five patients were males and 9 females. Forty four patients presented with features of systemic toxicity. All group A patients were managed by primary closure of perforation. In group B, ileostomy was performed in 20 patients after bowel resection, and the perforation was exteriorized in 22 patients with single perforation. Two patients had primary anastomosis. Overall mortality was 11.9%. Primary closure should be reserved for selective patients who present early, without gross peritoneal contamination. Patients who present late, or are severely ill, should be managed by ileostomy