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Typhoid Ileal Perforation: Comparative Study of Ileostomy Versus Primary Repair and associated Morbidity and Mortality


Article Information

Title: Typhoid Ileal Perforation: Comparative Study of Ileostomy Versus Primary Repair and associated Morbidity and Mortality

Authors: Shahzore Gul, Sughra Parveen, Mazhar Iqbal, Tanveer Ahmed, Imran Khan, Ali Nawaz

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2021-07-01 2022-06-30
Y 2020-07-01 2021-06-30
Y 1900-01-01 2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: 2

Language: English

DOI: 10.51253/pafmj.v73i2.7025

Keywords: IleostomyPrimary repairTyphoid ileal perforation

Categories

Abstract

Objectives: To study the result of primary repair with ileostomy in cases of typhoid ileal perforation.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Surgery, Jinnah Postgraduate Medical Center, Karachi Pakistan, from May 2019 to Jun 2020
Methodology: Participants who were operated on for typhoid ileal perforation were included, while patients who presented with a hollow viscus perforation other than ileal perforation were excluded from the study. Peritoneal lavage and exploration were performed. All per-operative findings were documented. In addition, the socio-demographic and clinical parameters, including the postoperative complications and morbidity/mortality, were documented.
Results: Out of the 73 individuals with ileal perforation included in this research, 52 underwent primary repair, whereas 21 underwent ileostomy. Patients who had undergone ileostomy had a higher morbidity (61.90%) and mortality (19.00%) rate than patients in the Primary Repair Group. In addition, patients in the ileostomy Group had significantly higher rates of wound dehiscence and infection, electrolyte imbalance, and weight loss than patients in the Primary Repair Group.
Conclusion: The current study indicates that primary repair is an ideal procedure for typhoid ileal perforation compared to an ileostomy.


Research Objective

To study the result of primary repair with ileostomy in cases of typhoid ileal perforation and compare associated morbidity and mortality.


Methodology

Quasi-experimental study involving participants operated on for typhoid ileal perforation. Patients underwent peritoneal lavage and exploration. Socio-demographic, clinical parameters, postoperative complications, morbidity, and mortality were documented. Statistical analysis was performed using SPSS version 23.0.

Methodology Flowchart
                        graph TD;
    A["Participant Selection Typhoid Ileal Perforation"] --> B["Peritoneal Lavage and Exploration"];
    B --> C["Document Intraoperative Findings"];
    C --> D["Divide into Groups: Primary Repair vs. Ileostomy"];
    D --> E["Document Socio-demographic and Clinical Parameters"];
    E --> F["Document Postoperative Complications, Morbidity, Mortality"];
    F --> G["Statistical Analysis SPSS"];
    G --> H["Compare Complication Rates, Morbidity, Mortality"];
    H --> I["Draw Conclusions"];                    

Discussion

The study indicates that primary repair is associated with lower rates of postoperative complications and morbidity compared to ileostomy in typhoid ileal perforation. While mortality rates did not differ significantly between the groups in this study, other studies suggest ileostomy may be preferred for patients with multiple perforations, elderly patients, or those with comorbidities.


Key Findings

Out of 73 individuals, 52 underwent primary repair and 21 underwent ileostomy. Patients who had ileostomy had higher morbidity (61.90%) and mortality (19.00%) rates compared to the primary repair group. Ileostomy patients also had significantly higher rates of wound dehiscence, wound infection, electrolyte imbalance, and weight loss.


Conclusion

Primary repair is a safer and more suitable procedure for typhoid ileal perforation, associated with lower overall morbidity. The surgeon should clinically assess each patient to make the most appropriate treatment decision.


Fact Check

- 73 individuals with ileal perforation were included in the study.
- Patients who underwent ileostomy had a morbidity rate of 61.90%.
- The study was conducted from May 2019 to June 2020.


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