CLINICAL PROFILE AND POSTOPERATIVE COMPLICATIONS OF TYPHOID ILEAL PERFORATION: A PROSPECTIVE STUDY IN A HIGH-PREVALENCE REGION

Abstract

Objective: To determine the clinical profile and complication in the post-typhoid period of perforation of Ileum in patients who had presented to a high-volume tertiary care surgical unit.

Background: Typhoid ileal perforation is a life-threatening surgical emergency that has been identified as a transmural necrosis at Peyer's patches in the distal ileum with the majority of cases occurring among young adults in areas with poor sanitation and a lack of safe drinking water. Enteric fever and its serious complications such as ileal perforation affect Pakistan and especially the Khyber Pakhtunkhwa province at disproportionately high rates. Even though it is a preventable condition, typhoid perforation still has a high post-operative morbidity and mortality rates in the resource limited areas, which is mainly due to late presentation and insufficient surgical facilities.

Study Place and Duration: Department of General Surgery Lady Reading Hospital Peshawar.

Methodology: This prospective observational study enrolled 86 consecutive patients of any age of both sexes who presented with typhoid ileal perforation showing on laparotomy after performing this procedure. The clinical profile was documented that included the demographic features, duration of symptoms, presenting signs, peri-op findings and surgeries performed. The postoperative complications of wound infection, faecal fistula, anastomotic leak, wound dehiscence, pneumonia and 30-day mortality were documented. SPSS version 25.0 was used to analyse data.

Results: The mean age was 28.4 ± 12.6 years with male predominance (72.1%). On average, symptoms developed over 6.8 ± 3.2 days prior to presentation. Findings intraoperatively systematically revealed that the most common was single perforation (67.4%). A simple closure was obtained in 54.7%, resection and anastomosis in 29.1% and ileostomy in 16.3% of patients. The most common complications post surgery were wound infection (32.6%), faecal fistula (15.1%) and mortality (11.6%).

Conclusion: Ileal perforation most commonly predisposes young males who present late with copious amount of peritoneal contamination for typhoid fever. The most frequent postoperative complications are wound infection or faecal fistula and overall postoperative mortality is not negligible. Surgery in the early stages, optimisation of peri- and post-operative care plus effective typhoid vaccination programmes are important to minimise morbidity and mortality from typhoid, which is preventable.