Typhoid perforation still a common problem: situation in Pakistan in comparison to other countries of low human development.

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.