Abstract
Introduction
Typhoid enteric perforation is a cause of high morbidity and mortality. This study aim is to determine the factors affecting morbidity in patients with typhoid enteric perforation.
Materials and methods
Ninety-six patients with typhoid enteric perforation were reviewed. The variables are defined as follows: Age, gender, complaints, perforation–operation interval, typhoid fever treatment before the perforation or not, white blood cell (WBC) count, hemoglobin level (Hgb), intraoperative peritonitis intensity, the number of perforations, and type of surgery were examined. To determine the independent risk factors that might affect morbidity in typhoid enteric perforation, we made use of multivariate logistic regression analysis.
Results
Nine variables were applied the univariate analysis, which were greater than 30 years (P = 0.218), male gender (P = 0.02), preoperative treatment (P = 0.147), less than or equal to 48 h perforation–operation interval (P = 0.013), greater than 4,000 K/UL WBC (P = 0.388), less than 8 g/dL Hgb (P = 0.026), greater than 29 Mannheim Peritonitis Index (P < 0.0001), multiple perforation number (P = 0.614), and primary repair (P = 0.105). Logistic regression analysis showed that Mannheim Peritonitis Index (P = 0.014) and perforation–operation interval (P = 0.047) were defined as independent risk factors affecting morbidity.
Conclusions
If liquid electrolyte, blood, antibiotics, and parenteral nutrition are applied in typhoid enteric perforation cases adequately, then severe peritonitis becomes an independent risk factor that affects morbidity. Early diagnosis and appropriate surgery type would decrease morbidity and mortality.
Similar content being viewed by others
References
Chouhan MK, Pande SK (1982) Typhoid enteric perforation. Br J Surg 69:173–175
Santillana M (1991) Surgical complications of typhoid fever: enteric perforation. World J Surg 15:170–1705
Akgun Y, Bac B, Boylu S, Aban N, Tacyildiz I (1995) Typhoid enteric perforation. Br J Surg 82:1512–1515
Mock CN, Amaral J, Visser LE (1992) Improvement in survival from typhoid ileal perforation. Results of 221 operative cases. Ann Surg 215:244–249
Kayabalı I, Gokcora IH, Kayabalı M (1990) A contemporary evaluation of enteric perforations in typhoid fever; analysis of 257 cases. Int Surg 75:96–100
Eggleston FC, Santoshi B (1981) Typhoid perforation: choice of operation. Br J Surg 68:341–342
Ihekwaba FN, Shittu AB (1991) Perforated typhoid enteidis. The problem of intestinal fistula. Trop Geogr Med 43:370–374
Abantanga FA, Wiafe-Addai BB (1998) Postoperative complications after surgery for typhoid perforation in children in Ghana. Pediatr Surg Int 14:55–58
Eustache JM, Kresi DJ Jr (1983) Typhoid perforation of the intestine. Arch Surg 118:1269–1271
Maurya SD, Gupta HC, Tiwari A, Sharma BD (1984) Typhoid bowel perforation: a review of 264 cases. Int Surg 69:155–158
Fugger R, Rogy M, Herbst F, Schemer M, Schulz F (1988) Validation study of the Mannheim Peritonitis Index. Chirurg 59:598–601
Hosoglu S, Aldemir M, Akalin S, Geyik MF, Tacyildiz IH, Loeb M (2004) Risk factors enteric perforation in patients with typhoid fever. Am J Epidemiol 160:46–50
Saxe JM, Cropsey R (2005) Is operative management effective in treatment of perforated typhoid? Am J Surg 189:342–344
Buttler T, Knight J, Nath SK (1985) Typhoid fever complicated by intestinal perforation: a persisting fatal disease requiring surgical management. Rev İnfect Dis 7:244–256
Van Basten JP, Stockenbrugger R (1994) Typhoid perforation: a review of the literature since 1960. Trop Geogr Med 46:336–339
Buttler T, Islam A, Kabir S, Jones PK (1991) Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea. Rev Infect Dis 13:85–90
Shukla VK, Sahoo SP, Chauhan VS, Pandey M, Gautam A (2004) Enteric perforation—single-layer closure. Dig Dis Sci 49:161–164
Khan M, Coovadia YM, Connolly C, Sturm AW (1999) Influence of gender on clinical features, laboratory findings, and complications of typhoid fever. Am J Trop Med Hyg 61:41–46
Onen A, Dokucu AI, Cigdem MK, Ozturk H, Otcu S, Yucesan S (2002) Factors affecting morbidity in typhoid intestinal perforation in children. Pediatr Surg Int 18:696–700
Stoner MC, Forsythe R, Mills AS, Ivatury RR, Broderick TJ (2000) Intestinal perforation secondary to Salmonella typhi: case report and review of the literature. Am Surg 66(2):219–222 (Feb)
Merier DE, Trapley JL (1998) Typhoid intestinal perforations in Nigeria children. World J Surg 22:319–322
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gedik, E., Girgin, S., Taçyıldız, I.H. et al. Risk factors affecting morbidity in typhoid enteric perforation. Langenbecks Arch Surg 393, 973–977 (2008). https://doi.org/10.1007/s00423-007-0244-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-007-0244-8