Different Surgical Options and Ileostomy in Typhoid Perforation

To find out the value of primary ileostomy as a life saving procedure in patients of typhoid ileal perforation. 112 diagnosed cases were included in this study with a mean age of 18.66 years with a male to female ratio of 1.5:1. After diagnosis and resuscitation, all of the patients were operated within 48 h of admission. The operative procedure was determined by the general condition of the patient, number of perforations and degree of peritoneal contamination. Primary ileostomy was done in moribund patients with massive faecal contamination of peritoneal cavity, while primary double layered closure of the perforation was attempted in clinically stable patients with a single perforation and resection followed by endtoend anastomosis was attempted in cases where there were more than one perforations or the perforation was present too close to the ileocaecal junction. Age ranged from 8 years to 50 years and the maximum number of patients were in the age group 31-40 years, with a male dominance. On laparotomy 98 (88.5%) patients had a solitary perforation in the terminal ileum and 14 (12.5%) patients had more than one perforation. Primary double-layered closure was done in 40 (35.71%) patients; primary ileostomy in 54 (48.21%) patients and resection followed by end-to-end anastomosis was done in remaining 18 (16.07%) patients. Faecal fistula was the most dreaded and fatal complication and was found to be commonest in patients where primary closure was done (07, 17.55). Over all mortality was (7.14%) of which 6 (5.35%) died secondary to the development of faecal fistula while one patient developed severe peri-stomal excoriation and progressive malnutrition leading to septicemia and death. Minimum hospital stay was associated with primary ileostomy patients and so was the complication rate. Primary ileostomy was found to be superior to other surgical procedures as far as the morbidity and mortality is concerned and especially so in moribund patients presenting late in the course of illness, where it proved to be a life saving procedure. We recommend that primary ileostomy is a safe way of managing typhoid ileal perforation.