Rajesh T. R, Biju P. R
BACKGROUND Typhoid is a major cause for non-traumatic ileal perforation in developing and under developed countries. 1,2,3,4,5,6 Other causes of non-traumatic ileal perforations worldwide include intestinal tuberculosis, 11 Crohn's disease, Behcet's disease, radiation enteritis, adhesions, ischemic enteritis and nonspecific ulcer. The public health burden of enteric fever in India is huge. Typhoid burden in some states and union territories in India, like Kerala, Mizoram, Sikkim, Goa etc. are much lower than the national rate. 16 The objectives of this study were- (a) To find out the causes of non-traumatic ileal perforations for which surgery is undertaken in our institution (b) To estimate the frequency of typhoid fever among non-traumatic ileal perforations. (c) To analyse the various surgical treatments offered and (d) To analyze morbidity and mortality among patients operated. MATERIALS AND METHODS This is a retrospective cohort study. During 2012 to 2017, a total of 62 patients with perforation peritonitis were identified as ileal perforations, at laparotomy. Data collected and analysed with the help of SPSS software Version 21.0. Basic statistical methods like percentage analysis were employed for the analysis of the data. RESULTS During the period 2012 to 2017, there were 62 patients with ileal perforations operated in our hospital. Age ranged from 17-76 years. Male: female ratio was 3.3: 1. Main symptoms were abdominal pain, vomiting and fever. Most patients had symptom duration 1 to 3 days. Only 4 patients had duration of more than 3 days. Pre-operative diagnosis was diffuse peritonitis in all these patients; ileal perforation was identified only on laparotomy. Gas under diaphragm was present only in 23% of patients. All patients underwent laparotomy under GA +/- Epidural anaesthesia, after initial resuscitation. Majority of patients had single perforation involving distal ileum. CONCLUSION Typhoid is not a common cause for non-traumatic perforation of ileum in Kerala in recent years. The common causes are nonspecific ulcers (66%) and tuberculosis (19%). Most common procedure was resection of affected segment with end to end anastomosis (74%). Overall morbidity was 19.2% and mortality 7.6%.
