Singh Gurjit, Dogra Bharat Bhushan, Jindal Neha, Rejintal Santhosh
Department of General Surgery, Padmashree Dr. D. Y. Patil Hospital and Research Centre, Pune, Maharashtra, India.
J Family Med Prim Care. 2014 Apr;3(2):132-5. doi: 10.4103/2249-4863.137633.
To determine clinical features, operative findings and post-operative complications in patients operated for non-traumatic ileal perforation and to discuss the role of typhoid vaccination.
A retrospective study was carried out from 2009-2010. Seven patients were admitted through casualty as cases of acute abdomen. Underlying conditions were typhoid ulcers (4 patients) and non-specific etiology (3 patients). Diagnosis was made on clinical grounds, laboratory investigations, radiology and operative findings. Exploratory laporotomy was done. Different variables studied post-operatively were wound infection, residual abscess, recurrence and delayed post-operative complications.
Tenderness, distension and rigidity were found in maximum patients. Gases under diaphragm and air fluid levels were common radiological findings. However, widal test and blood culture for S. typhi was positive in four patients. Six patients had single perforation and one patient had two perforations, all being on antimesentric border of ileum. Maximum patients had peritoneal collection of less than 1000 ml. In five patients simple closure of perforation was done and in remaining two resection with end to side ileotransverse anatomosis was required. Wound infection and residual intraabdominal abscess were found in one patient each.
Management criteria remain same in typhoid and non-specific perforations. Commonest cause of ileal perforation is typhoid fever in our country, so immunization against typhoid beyond 18 years of age is recommended.
确定因非创伤性回肠穿孔接受手术治疗患者的临床特征、手术发现及术后并发症，并探讨伤寒疫苗接种的作用。
进行一项2009年至2010年的回顾性研究。7例患者因急腹症经急诊入院。潜在病因包括伤寒溃疡（4例患者）和非特异性病因（3例患者）。根据临床表现、实验室检查、影像学检查及手术发现做出诊断。进行了剖腹探查术。术后研究的不同变量包括伤口感染、残余脓肿、复发及术后延迟并发症。
大多数患者有压痛、腹胀和腹肌紧张。膈下游离气体和气液平面是常见的影像学表现。然而，4例患者肥达试验和伤寒杆菌血培养呈阳性。6例患者有单个穿孔，1例患者有两个穿孔，均位于回肠的对系膜缘。大多数患者腹腔积液少于1000ml。5例患者行穿孔单纯缝合，其余2例需要行回肠横结肠端侧吻合切除术。各有1例患者发生伤口感染和腹腔残余脓肿。
伤寒穿孔和非特异性穿孔的治疗标准相同。在我国，回肠穿孔最常见的原因是伤寒热，因此建议18岁以上人群接种伤寒疫苗。
