Role of proximal catheter ileostomy in typhoid enteric perforation

ABSTRACT

Addition of loop ileostomy with surgical repair of typhoid enteric perforation has recently reduced mortality rates but ileostomy itself is associated with high complication rates of 25-40%. This study was done to assess the effectiveness of proximal catheter ileostomy in these patients. Prospective study. J N Medical College Hospital, Aligarh Muslim University, Aligarh, India. Patients with typhoid enteric perforation who were treated surgically from November 2006 to November 2009. Proximal catheter ileostomy constructed along with primary surgical repair of typhoid enteric perforations when proximal defunctioning of bowel was considered advisable. Feasibility as well as outcome in terms of morbidity and mortality. Catheter ileostomy was performed in eight patients with typhoid enteric perforations treated by surgical repair. Patients' age ranged from 17 to 45 years [average 25.75 years] with a male to female ratio of 11. In the immediate postoperative period, two patients died of septicemia unrelated to catheter ileostomy. Catheter ileostomy started functioning within 48 hours of the operation and twice-daily irrigation was found sufficient. One patient developed mild peritubal leak that cleared within two days. Laparotomy wounds got infected in two patients. Ileostomy wounds closed spontaneously in all patients within 7-14 days after catheter removal. Mean hospital stay was 13.4 days. Follow-up was from 6- 36 months [average 24 months]. Catheler ileostomy is effective and safe in protecting primary repair of typhoid enteric perforations with minimal morbidity