Ahmed Hafiz Naweed, Niaz Mohammad Pervaiz, Amin Mohammad Amjid, Khan Mushtaq Hussain, Parhar Allah Buksh
Islamic International Medical College Railway Hospital, Multan.
J Pak Med Assoc. 2006 May;56(5):230-2.
The objective of this study was to analyze the present situation of typhoid perforation and the factors behind the still common occurrence of the disease in our country. The study was conducted with the collection and retrospective analysis of the data of typhoid perforation treated in surgical unit III of Nishtar Hospital, Multan from January 1998 to September 2000. All the patients were received and operated upon in emergency ward of the hospital, after initial resuscitation as necessary investigation. Primary closure of perforation or primary exteriozation as loop ileostomy were the surgical options adopted. Among 31 patients, 25 were male and 7 female, with a male to female ratio of 3.57:1. Majority of patients were 15-30 years of age. Twenty six (81.25%) were from remote rural areas while only 6 (18.75%) were city dwellers. One patient expired before operation and 30 underwent exploratory laparotomy. Overall expiry rate was 12.5%. Wound infection and burst abdomen were the major post operative complications responsible for prolonged hospital stay. The factors leading to occurrence of typhoid perforation were identified as, lack of civic facilities like clean drinking water and sewage disposal, poverty, poor yield of primary health care system causing a delay in diagnosis and atypical presentation of typhoid and perforation due to the emergence of multi drug resistant strains of salmonella typhae. The results of the study were similar to those of Indian studies but better than African studies. The situation warrants attention of health care providers and policy makers.
本研究的目的是分析我国伤寒穿孔的现状以及该病仍然常见的背后因素。该研究通过收集和回顾分析1998年1月至2000年9月在木尔坦尼什塔尔医院第三外科治疗的伤寒穿孔数据进行。所有患者均在医院急诊病房接受治疗并手术，在进行必要的初步复苏后进行必要的检查。手术选择包括穿孔的一期缝合或作为回肠造口术的一期外置。31例患者中，男性25例，女性7例，男女比例为3.57:1。大多数患者年龄在15至30岁之间。26例（81.25%）来自偏远农村地区，而只有6例（18.75%）是城市居民。1例患者在手术前死亡，30例接受了剖腹探查术。总体死亡率为12.5%。伤口感染和腹部裂开是导致住院时间延长的主要术后并发症。导致伤寒穿孔发生的因素被确定为缺乏清洁饮用水和污水处理等市政设施、贫困、初级卫生保健系统的低产出导致诊断延迟以及由于伤寒沙门氏菌多重耐药菌株的出现导致伤寒和穿孔的非典型表现。该研究结果与印度的研究结果相似，但优于非洲的研究。这种情况值得医疗服务提供者和政策制定者关注。
