Typhoid ileal perforation: the value of delayed primary closure of abdominal wounds.

Twenty-four patients with typhoid perforation of the terminal ileum operated on over a period of 1 year were studied to evaluate delayed primary closure of abdominal wounds. Twenty patients with the same diagnosis had primary wound closure to serve as control. Over 80% of the patients were between 1st and 3rd decades of life. The male:female ratio was 3:1 to 4:1. Mean duration of symptoms was 9.83 and 11.25 days while that of peritonitis was 2.87 and 2.50 days for the study and control groups, respectively. Terminal ileal perforations were confirmed in all and mean volume of pus and faeculent peritoneal fluid were 529 ml and 482 ml, respectively. Wound infection occurred in 70.8% and 70% of the study and control groups, respectively. Other complications such as wound dehiscence occurred in 37.5% and 35%, residual intraabdominal abscess in 8.3% and 10%, and faecal fistula in 8.3% and 10% of the study and control groups, respectively. Mortality was in 25% and 20%, respectively. The above results suggest that delayed primary closure has no value in preventing abdominal wound infection in typhoid perforation.