González Ojeda A, Pérez Ríos A, Rodríguez M, de la Garza Villaseñor L
Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F.
Rev Gastroenterol Mex. 1991 Apr-Jun;56(2):77-81.
This is a retrospective review of 10 consecutive patients with intra-abdominal complications of typhoid fever requiring surgical treatment, during a four-year period at the Instituto Nacional de la Nutrición Salvador Zubirán. There were 7 males and 3 females with an average age of 33.9 years. In 80 per cent of the cases Salmonella typhi was obtained in blood and bone narrow cultures. Five cases developed terminal ileum perforations, 4 massive bleeding related to ulcerated typhoid ileitis and one patient was operated on with the preoperative diagnosis of acute abdomen during the course of severe, toxic, typhoid fever. At laparotomy, no abnormalities were found. Five patients were treated with right hemicolectomy, 3 with local resections and primary closure, and another one, with segmental terminal ileum resection and end to end anastomosis. One patient died of mixed shock and multiple organ failure. This event was secondary to partial dehiscence of the ileo-transverse anastomosis and massive bleeding. Four patients had complications; a) pneumonia, b) urinary tract infection, c) splenic abscess that required splenectomy and: d) intestinal obstruction. All patients were treated with chloramphenicol. We found a high morbidity and mortality rate of the typhoid fever complications. The surgical resection and specific antibiotic therapy are the most effective treatment, however, complications can appear during its treatment.
这是对墨西哥国立营养研究所萨尔瓦多·苏比拉án分院在四年期间连续10例需要手术治疗的伤寒性腹部并发症患者的回顾性研究。患者中男性7例，女性3例，平均年龄33.9岁。80%的病例血培养和骨髓培养检出伤寒杆菌。5例发生回肠末端穿孔，4例因伤寒性回肠炎溃疡导致大量出血，1例患者在严重中毒性伤寒热病程中因术前诊断为急腹症而接受手术，术中未发现异常。5例患者接受了右半结肠切除术，3例接受了局部切除并一期缝合，另1例接受了回肠末端节段性切除并端端吻合术。1例患者死于混合性休克和多器官功能衰竭，该事件继发于回肠-横结肠吻合口部分裂开和大量出血。4例患者出现并发症：a)肺炎，b)尿路感染，c)脾脓肿需要行脾切除术，d)肠梗阻。所有患者均接受氯霉素治疗。我们发现伤寒热并发症的发病率和死亡率很高。手术切除和特异性抗生素治疗是最有效的治疗方法，然而，治疗过程中可能会出现并发症。
