THE CHOICE OF SURGICAL PROCEDURE IN TYPHOID ILEAL-PERFORATION

Perforation of the bowel is the most serious complication of typhoid fever. The role of early limited surgery needs to be assessed. This prospective study includes 96 patients with typhoid enteric perforation who under went operative treatment and were divided into two groups each with 48 patients. Group A (early) includes all those cases who had single perforation and history of peritonitis was less than 48 hours. Primary closure after wedge excision of perforation was done. Group B (late) includes those cases who presented with history of peritonitis for more than 48 hours with single or multiple perforation. Primary closure after wedge excision of perforation with addition of proximal Ileostomy was done. This study looks at prognostic indices and therapeutic options. The common age group affected was in second and third decade of life with seasonal variation. Widal agglutination test was positive in 79.90 % cases. Pneumoperitoneum at radiography was present in 39 cases (43.33 %). The incidence of wound infection (14.6 %), wound dehiscence (6.25 %), chest infection (6.25 %), acute renal failure requiring haemodialysis (4.17 %) were high in group B and similarly mortality was high in the group (6.25 %). Early diagnosis is the key to the whole problem and similarly early surgery with peritoneal lavage provides optimum results.