Role of Ileostomy in the Management of Late Cases of Typhoid Intestinal Perforation

Objective: To evaluate the outcome of loop illestomy in late cases of illeal typhoid perforation in terms of duration of hospital stay, morbidity and mortality in our set up. Methodology: This prospective study was conducted at Khyber medical University (KMU), Institute of Medical Sciences, Kohat from January 2005 to January 2011. We studied 58 consecutive cases having ileal typhoid perforation of more than 24 hours duration who underwent surgery followed by loop ileostomy. Data was collected on a structured proforma including patient’s demographics, clinical features with relevant investigations, operative findings, postoperative complications and length of hospital stay. Patients were regularly followed up for complications. Results: A total of 58 cases were studied over 6 years duration. Fever, abdominal pain, guarding and tenderness in either right iliac fossa or whole abdomen was observed in all 58/58 (100%) cases. Widal test and blood culture was found positive in 25 (43.1%) and 30 (51.72%) of the cases respectively and gas under Rt hemidiaphram was seen in (79.31%) of cases. A single perforation of <1 cm size was found on the antimesenteric border of terminal ileum in 51/ 58 (87.9%) cases. Wound infection (n=15, 26.3%) and peristomal excoriation of skin (n=11, 19.2%) were common postoperative complications. Mean hospital stay was 7.53+4.9 days and median hospital stay was 6 days. Mortality rate was 3.45 % in our study. Conclusion: Loop Ileostomy is a safe procedure having good outcome in terms of low morbidity, mortality and hospital stay in properly selected cases of illeal typhoid perforation.