Comparison of three operations for typhoid perforation.

BACKGROUND

Typhoid fever is a public health problem in the developing world and gut perforation remains the major complication with a high associated mortality rate. Even though most surgeons agree that elimination of peritoneal soilage and endotoxaemia by surgery offers the best hope of survival, the extent of surgery remains controversial. This prospective study compared the results of three operations for this condition.

METHODS

A total of 64 patients with clinical suspicion of typhoid perforation were treated by one of three operations (simple closure, wedge excision and anastomosis or segmental resection and anastomosis) at this hospital. The management protocol was the same for the three groups. The risk of reperforation, mortality rate and duration of hospital stay were compared.

RESULTS

The risk of reperforation and mortality rate were highest (two and 13 of 21 respectively) in patients who had wedge excision and lowest (zero and nine of 25 respectively) in those who had segmental resection. The risk of reperforation and mortality rate were zero and nine of 18 respectively in the simple closure group.

CONCLUSION

Segmental resection seems to be the best treatment for typhoid perforation and is recommended for surgeons practising in a similar environment.