Title: Clinico-pathological Study of Different Modalities of Surgery of Typhoid Perforation Treatment
Authors: Dr Mamun Ibn Munim, Dr Guljar Ahmed, Dr Hasina Choudhury, Dr Mushfiqur Rahman, Dr Moontaha Choudhury
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.128
Abstract
Introduction: Small bowel perforation is a common surgical emergency all over the world .The spectrum of etiology of small bowel perforation differs from its western counterpart. Typhoid fever is a protracted disease that includes bacteremic phase with fever and chills during the first week, wide spread reticulo-endothelial involvement with rash, abdominal pain and prostration in the second week and ulceration of Payer’s patches with intestinal bleeding and perforation during the third week.
Objective: The main goal of our study is to identify the suitable treatment of typhoid perforation by comparing different modalities of surgery.
Methodology: This cross-sectional observational study was conducted in the different units of Department of Surgery Sylhet MAG Osmani Medical College Hospital during 1st January 2010 to 31st December 2011. A total 63 patients with typhoid ulcer perforation were enrolled in this study.
Results: Out of 63 typhoid ulcer patients 4 (6.35%) patients were below the age of 20 years. The mean age of this group of patients was 18.76 (± 0.39). 32 (50.79%) patients were found between the ages of 20 – 40 years. Among them 48 (76.19%) patients were male and 15 (23.81%) patients were female. All 63 (100%) patients presented with abdominal pain. Total number of complication exceeds the total number of patients as the more than one complication occurred in one patient. Complications occurred in 7 (33.33%) patients who came to the hospital within 48 hours and 14 (66.66%) patients in those whom came to the hospital after 48 hours of onset of symptoms. Total complication occurred in 21 patients. The association between time lapse in hospitalization and post-operative complication is statistically significant (p<0.05). There is significant difference between the death of the patients who reached earlier in the hospital and who are not (p<0.05). we can conclude that In case of early presentation - repair of perforation with proximal ileostomy and in case of late presentation - resection, end to end anastomosis with proximal ileostomy have the better outcome.
Keyword: Small bowel perforation, Typhoid fever, Typhoid ulcer perforation.
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