To Evaluate the Prognostic Factors Involved in Cases of Intestinal Perforation Caused by Typhoid Fever.

Shua Haq, Mahnoor Irshad, Zainab Zaman


Objective: The main aim of this study was to evaluate the prognostic factors involved in cases of intestinal perforation caused by typhoid fever.

Place and Duration of Study: This study was carried out in North Surgical Department of Mayo Hospital Lahore from January 2018 to November 2018.

Materials and Methods: A total of 62 patients were selected for the study who were diagnosed with intestinal perforation due to typhoid fever. Diagnosis was made on clinical basis and with the help of Widal test. X-ray abdomen erect and supine was obtained which showed air under diaphragm. Patients were initially resuscitated and exploratory laparotomy was done which showed perforation in the small intestine. Patients were kept in HDU and vitals were monitored 4 hourly and data of each patient was recorded in predesigned proforma.

Results: Out of total 62 patients 20% were female patients while 80% were male patients. Single perforation was seen in 84% of the cases while multiple perforation were seen in 16% of the patients. Wound dehiscence, wound infection, septicemia, residual abscess and fecal fistula like complications were seen in 80% of the patients. Mortality was increased by number of factors which included delayed surgery, excessive fecal material, delayed presentation to hospital and multiple perforations. The death rate was around 17.7% (11/62). 

Conclusion: Septicemia, excessive abdominal fluid, fecal fistula, multiple perforations, duration of operation, mortality, duration of disease and rupture of abdomen are greatly affected by typhoid related intestinal perforation. Long hospital stay is seen in some cases in which wound gets infected and with the presence of fecal fistula.

Keywords: Prognostic factors, mortality, intestinal typhoid perforation.

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Grieco, Michele, Giorgia Polti, Lara Lambiase, and Diletta Cassini. "Jejunal multiple perforations for combined abdominal typhoid fever and miliary peritoneal tuberculosis." Pan African Medical Journal 33, no. 51 (2019).

Singh, Upendra Prasad, Ravindra Kumar, Gyanendra Singh, and Richa Chauhan. "Tube caeco-ileostomy with repair: An innovative surgical technique for typhoid perforation." International Journal of Surgery 3, no. 1 (2019): 349-353.

Lindsay, S., Garrett, D. and Steele, D., 2019. Evidence to Action: The 10th International Conference on Typhoid and Other Invasive Salmonelloses. Clinical Infectious Diseases, 68(Supplement_1), pp.S1-S3.

Jain, Ankur, Gaurav Baheti, and Varshil Mehta. "Steroid Pulse Therapy in the Management of Neuro-psychiatric Manifestations in an Atypical Presentation of Typhoid Fever." Journal of Case Reports and Series 1, no. 1 (2019): e000004-e000004.

Parry, Christopher M., Isabela Ribeiro, Kamini Walia, Priscilla Rupali, Stephen Baker, and Buddha Basnyat. "Multidrug resistant enteric fever in South Asia: unmet medical needs and opportunities." bmj 364 (2019): k5322.

Yousafzai MT, Qamar FN, Shakoor S, Saleem K, Lohana H, Karim S, Hotwani A, Qureshi S, Masood N, Rauf M, Khanzada JA. Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine. Clinical Infectious Diseases. 2019 Feb 15;68(Supplement_1):S16-21.

Essa, F., Hussain, S.Z.M., Batool, D., Usman, A., Khalid, U., Yaqoob, U. and Shahzad, H., 2019. Study of Socio-Demographic Factors Affecting the Prevalence of Typhoid. Annals of Medical and Health Sciences Research, 9(1).

Salem, Yousif, Keith Johnston, and Amro Salem. "Typhoid fever colitis with massive lower gastrointestinal bleeding." International Surgery Journal 6, no. 2 (2019): 601-603.

Sahastrabuddhe, Sushant, and Tarun Saluja. "Overview of the Typhoid Conjugate Vaccine Pipeline: Current Status and Future Plans." Clinical Infectious Diseases 68, no. Supplement_1 (2019): S22-S26.

Henschel, MOTOULA LATOU Noé, MASSAMBA MIABAOU Didace, NOTE MADZELE Murielle Etiennette Julie, and Carmich Daimler N'ZAKA. "Multiple Intestinal Perforation In Crohn's Disease." Journal of Medical Care Research and Review 2, no. 3 (2019): 120-122.

Stanaway, Jeffrey D., Robert C. Reiner, Brigette F. Blacker, Ellen M. Goldberg, Ibrahim A. Khalil, Christopher E. Troeger, Jason R. Andrews et al. "The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017." The Lancet Infectious Diseases (2019).

Khokar, Imran, and Samiya Naemullah. "Comparison of Oral Azithromycin and Intra Venous Ceftriaxone for Treatment of Uncomplicated Enteric Fever in Children." Journal of Rawalpindi Medical College 23, no. 2 (2019): 64-67.

Chatham-Stephens, K., Medalla, F., Hughes, M., Appiah, G.D., Aubert, R.D., Caidi, H., Angelo, K.M., Walker, A.T., Hatley, N., Masani, S. and Nash, J., 2019. Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan—United States, 2016–2018. Morbidity and Mortality Weekly Report, 68(1), p.11.

Chauhan, Sapna, Sachin Sharma, and Paramjit Singh Surender. "Concurrent dengue and typhoid infection: study from a tertiary care centre in Muzaffarnagar, India." International Journal of Research in Medical Sciences 7, no. 5 (2019): 1615.

Nussbaum, Michael S., and David W. McFadden. "Gastric, duodenal, and small intestinal fistulas." In Shackelford's Surgery of the Alimentary Tract, 2 Volume Set, pp. 886-907. Content Repository Only!, 2019.


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